What We Do

Healthcare Payer

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.

Solutions

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.

Show More

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
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 Management
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.

Provider management
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.

ICD-10 Solutions
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.

Impact

Ready to
Explore?