Smarter Claims. Stronger Performance.
Driving payer success through smarter data, faster adjudication, and better outcomes.
Inaccurate claims and fragmented processes don’t just disrupt your bottom line, they affect member satisfaction, provider relationships, and compliance risk.
Health plans need a partner who can help streamline claims management from end to end, uncover hidden inefficiencies, and ensure payment accuracy — without adding complexity.
Health plans need a partner who can help streamline claims management from end to end, uncover hidden inefficiencies, and ensure payment accuracy — without adding complexity.
+
1.1
metric efficiency for all health plans.
$
1
Million
in annual savings for clients from clinical and code reviews.
1
%
reduction in out-of compliance cases through cognitive OCR solution.
Enrollment and Claims Processing Capabilities
At Sagility, we combine deep healthcare domain expertise with advanced analytics, automation, and clinical insight to deliver intelligent, integrated claims solutions that improve speed, accuracy, and financial performance.
We bring the right blend of people, process, and technology to solve complex healthcare challenges — so your claims ecosystem works smarter, not harder.
1
M+
Claims Processed Annually
Enrollment Capabilities
Our priority when managing enrollment services is to promote operational efficiency, enhancing member and provider satisfaction.
- Application intake
- Onboarding and eligibility
- ID card fulfillment
- Member maintenance
- Billing and reconciliation
>
1
K
FTEs
Benefit Configuration
Processing claims efficiently and accurately requires ensuring that benefit rules, such as copayments, deductibles, annual maximums, are system ready.
- Plan and group setup
- Contract terms
- Provider and service mapping
- Prioritization rules
1
+
Years of Experience
Claims Processing
Our Center of Excellence employs a blend of process innovation, workflow automation, and hands-on expertise to deliver the most value to all plan types.
- Paper, electronic, image intake
- Intelligent content processing
- Touchless claims
- Automated claims workflows
- Electronic Data Interchange integration
$
1
Billion
Payouts Annually
AI and Automation
We ensure claims accuracy through a combination of tools, including automation, AI, and machine learning, that enable real-time error detection.
- Optical Character Recognition and Natural Language Processing
- Automated data extraction and validation
- Adjudication and fraud detection
- Intelligent medical coding
- AI-assisted correction for managing denial and appeals
Claims Lifecycle
At Sagility, we go beyond the typical claims processing by establishing a Claims Center of Excellence (CCoE). Our approach is a blend of process innovation, workflow automation, and hands-on expertise.
Explore Our Full Suite of BPO Services
Digital Mailroom
We ensure an end-to-end processing of inbound mail to handle everything from structured documents such as Claim forms to complex documents like Appeals and Medical Records.
Claims BPaaS
Our Claims BPaaS solution combines operations and technology that seamlessly integrates with client retained platforms and processes.
Grievance & Appeals
We take a comprehensive approach: meticulous record management, in-depth reviews and resolution, error handling, and preventive measures to reduce future inaccuracies.
Sagi360
This service is our framework for operational efficiency, providing a 360-degree view of operations: integrating call center, claims management, and back-office functions into one cohesive system.
Case Studies
See how we’ve helped payers unlock millions in savings and streamline operations:
Insights & Resources
Stay informed with the latest thinking on healthcare payer operations: