What We Do
Generating Healthcare Impact
Healthcare payers are in the midst of unprecedented transformation as rising healthcare costs, changing patient demographics, stringent regulations, and empowered consumers push for a smarter and more efficient healthcare system for tomorrow.
Genpact partners with over 70 healthcare companies, including the top four US national payers, harnessing best practices and deep domain expertise across the continuum of care delivery—payers, providers, and life sciences and durable medical equipment providers. We help them improve quality of care for patients while improving efficiency, driving customer satisfaction and retention, managing risk and compliance, and providing them the necessary agility to compete in a dynamic environment.
We make healthcare payer operations intelligent by designing, transforming, and running their processes through advanced operating models that harness technology and analytics through appropriate organizational design, focused to where they can deliver the most impact. The result is Intelligent OperationsSM.
Healthcare Claims Operations
Genpact helps healthcare payers design, transform, and run end-to-end claims operations to achieve greater efficiency in back- and front-office operations, while reducing the administrative cost of claims and claims leakage and improving provider and member satisfaction.
More than 70 healthcare payer and provider clients trust us for their operational excellence. We help them adapt key processes such as product development, membership and billing, claims processing, and customer service operations to the dynamic healthcare environment leveraging end-to-end technology solutions, including consulting, enterprise application services, and infrastructure management services.
Research content and presentation services and information science applied to marketing sales and services, risk, and finance and accounting functions. Our specialized analytics solutions for healthcare payers support population health management, accountable care organizations, end-to-end claims and managed market access, and pricing.
Finance & Accounting Services
Genpact Finance and Accounting services include Accounts Payable, General Accounting, Accounting, Closing & Reporting (ACR), Treasury, Tax Services, Financial Planning & Analysis, and F&A Systems of Engagement.
Our expertise covers the full spectrum of healthcare services: facility, professional, dental, vision/hearing, and Medicare and Medicare Advantage, including extensive experience with direct-to-plan payer solutions.
We provide support for end-to-end transactional processes as well as project-based and resource solutions, including the following:
Accountable Care Organizations
Our knowledge of both payer and provider operations, information flows, and technology landscapes helps deliver solutions for population identification and management, master data management and data warehousing, business intelligence, contract management support, and customer service. Our Data-to-Action AnalyticsSM enables a 360 degree view of the patient that helps identify chronic and/or high-risk patients, supports value-based payment models, and allows payers to ensure quality and cost-effective patient care.
Membership management, such as enrollment, eligibility, premiums, and policy maintenance. We proactively reduce the number of member queries by analyzing customer behavior and focusing on predicting and resolving the customer's issues on the first call.
Benefits analysis related to new group enrollment, instituting group-wide changes and other mandated activities, testing services and support for effective implementation of these new benefit plans.
Database management, credentialing, contracting services, pricing maintenance, and configuration enable improvements in medical loss ratios (MLR) and business performance. Our healthcare payer analytics provide the insights you need to negotiate fair and accurate rates with providers, ensuring superior care at fair prices.
Planning, business alignment, systems change management, staff training, and testing for all ICD-10 migration activities. Our proprietary FX Healthcare Engine's Product Payer Suite improves the speed and effectiveness of migrations while enhancing the Software Development Life Cycle (SDLC) with tools that support the quick and reliable implementation of projects.
Our Smart Enterprise Processes (SEPSM) proprietary framework help payers reimagine how they operate by integrating Genpact's effective Systems of EngagementTM, core IT, and Genpact Data-to-Action AnalyticsSM and enables customers to quickly realize tangible business outcomes.
A major healthcare payer saved US$80 million through the implementation of an analytics-led fraud detection model capable of spotting potentially fraudulent or erroneous claims.
A US payer entity increased collections by 179% by eliminating revenue leakages after the implementation of an end-to-end collections process redesign solution that employed analytics and real-time reporting.
A leading pharmacy benefits management company generated a business impact of US$78 million through improvement in patient advocacy and customer service operations by a combination of metrics reviews, FTE assessment, process standardization, and better integration of data.
The largest US-based payer and informatics company saved US$127 million (including US$ 54 million through operational improvements and US$13 million in productivity improvements) through an integrated solution comprising analytics, informatics, claims processing, software development, and business intelligence reporting, as well as application testing and maintenance.