The Sagility Claims Difference

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. Our claims team works relentlessly to improve processes and prepare for handling complex claims to deliver the most value possible for all product lines: Commercial, Medicare, Medicaid, and Government Programs, while taking care of contractual, medical policy, and coding outliers.

  • Handle 72 million claims annually, amounting to $65 billion in payouts.
  • Metric efficiency of +99.9 for all health plans.
  • $100 million in annual savings for clients from clinical and code reviews.


Contact us now to explore our full suite of traditional BPO services such as Mailroom, First Pass, Rework, and Grievance and Appeals, or as an all-encompassing BPaaS solution.

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Digital Mailroom

Sagility’s end-to-end solution for processing inbound mail can handle everything from structured documents such as Claim forms to complex documents like Appeals and Medical Records. Imaged physical mail and faxes are routed through our OCR and NLP engines to identify the documents and routes them through the proper data extraction algorithm all verified by our team of verification experts and then output into standard formats (e.g., 837 EDI messages) and the images and data are uploaded into your document management system. Each piece of mail is tracked throughout its lifetime in our document processing datastore and summarized in our user-frineldy dashboard and reporting portal. Our highly-scalable system can support processing small batches of mail up to millions of documents annually.

Claims BPaaS

Our Claims BPaaS solution combines operations and technology that seamlessly integrates with client retained platforms and processes. We take a holistic approach to facilitate all aspects of Claims processing, providing a robust solution that enables:


  • Streamlined claims processing – Our integrated service enhances efficiency with end-to-end claims processing capability.
  • Hybrid delivery model – Pairing Sagility and client platforms provides a comprehensive, effective claims management solution that strikes a perfect balance between cost and value.
  • Expanded functionalities – Additional services such as EDI Management and DMS are included. This in combination with optional payment integrity services opens up additional opportunities for improving claims efficiency.
  • Partnership with industry leaders – We collaborate with leading Claims Administration and G&A software providers for a more robust and extended service offering.
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Grievance and Appeals

Handling Grievance and Appeals (G&A) can often be a complex and time-consuming process for payers. Our comprehensive methods include meticulous record management, in-depth reviews and resolution, error rectifications, and preventive measures to reduce future inaccuracies. 


Whether it’s coverage, treatment, or payment related disputes, managing cost-sharing payments or coordinating benefits, Sagility helps streamline G&A administration and compliance adherence, leading to improved cost-efficiency, increased satisfaction levels, and a reduction in G&A incidence rates. With a core focus on these elements, we’re able to prevent member and provider abrasion, while at the same time ensuring compliance to regulations and guidelines established by CMS.

Achieving Significant Scale to Support HealthRules Payer Migration

Aiding a longstanding health plan partner migrate their $3 million Medicare Advantage membership plans to HealthRules Payer seamlessly.

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Claims Automation Saves $1.5M for Leading Payer

Achieving smooth healthcare claims processing became a critical issue for one of the top five payers in the industry, who requested Sagility’s help to improve their claims processes.

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Cognitive Appeals Automation Cuts Costs by 50%, Spikes Star Ratings for Major Payer

A leading national health insurance company used Sagility’s intelligent machine learning solution, leading to cognitive appeals automation cutting costs by up to 50%.


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