Do more with less across your entire organization with insightful, end-to-end claims management.
Claims outsourcing is rife with metrics — accuracy, turnaround time, etc. Claims metrics alone, however, miss the mark in yielding meaningful benefits to your organization.
The truly meaningful benefits are hard to measure in siloed claims departments — such as brand perception improvements, new member referrals, satisfaction levels, etc.
Only a true partner with a view of the end-to-end claims process can deliver value-added benefits to claims and your organization as a whole.
Sagility, a leader in transformative healthcare solutions, can manage all or singular aspects of claims, help you avoid the downstream impacts of mishandled claims, and truly differentiate your organization.
Improve intake processes.
Increase speed and efficiency.
Reduce inaccuracies and rework.
Enhance provider and member satisfaction.
Reduce fraud, waste, and leakage.
Optimize claim payment and support.
Reduce grievances, complaints, and calls.
Protect the brand and improve perception.
Improve scalability and business continuity.
Increase transparency and trust.
While most claims adjudication processes have been automated, what falls out of auto-adjudication are the highly complex claims. Resolving issues with these claims requires an understanding of plans, members, and providers; adjudication platform(s); as well as the contractual, medical policy, and coding outliers. With a deep understanding of both payer and provider operations, we partner with you to continuously improve and innovate.
Exceed service level targets with optimized software — Facets, QNXT, HealthRules Payor, InsPro, Amisys, PowerHMS, Mainframes, and more.
With an in-house Sagility Technology team and an understanding of upstream and downstream impacts of system changes, our team can help you overcome IT obstacles with:
50 states we work with regional plans and the largest national plans
72 Mclaims handled annually
$65 Bin payouts handled annually
20different claims platforms
+99.9metric efficiency for all health plans
3.5 yearsaverage tenure for claims agents
$100 Msavings for clients every year, resulting from clinical and code reviews
6100 FTEsacross 3 different geographies
Our claims specialists train for an average of six months. They are fully equipped to handle rework and the 20% of claims that require a complete review and application of benefits, pre-authorization decisions, and contractual carve-outs.
We take a “can do” approach to claims, as we aim to provide value, not just metrics. We proactively flag pre- and post-pay deficiencies so they may be investigated to avoid further issues.
Our Claims Center of Excellence (CCoE) harvests the very best ideas to promote collaboration and continuous improvement.
The CCoE is involved in: