For payers

Provider experience


Operational efficiencies across the lifecycle to drive savings, resolution, and satisfaction

Provider relationships are increasingly vital to health plan success

Today’s health plans require a deeper talent pool of experienced team members who can serve as brand ambassadors, helping build partnerships across providers. For our national payer clients, our solutions drive real outcomes and enhance value for providers through our proven solutions across vast lines of business, including Medicare, Commercial, Specialty, and International business segments.

Our customer care heritage and healthcare domain expertise combine to reduce hold times, bridge multiple handoffs, enable enhanced FCR, and maximize efficiencies with digital, automation, AX, and AI enablement.

To support the front lines of your customer satisfaction, we can leverage our decades of healthcare/customer care expertise with:

  • Best-in-class people and process management to reduce the learning curve while improving provider experience and ensuring faster resolution
  • Digital innovations, including automated audio transcriptions to enable automated interaction and data analytics
  • Partnership-based outsourcing with aligned outcome metrics across provider calls

Sagility delivers a provider call handling approach that increases satisfaction and accessibility —
for providers and patients.

Services for better provider engagement

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Customer service

Coverage benefits and eligibility inquiries, claims status and payment inquiries, and over-payment recovery, initial processing of preauthorization requests, address change requests, bank information retrieval, assists in claims reprocessing requests, benefit interpretation inquiries, and verification of benefits letters and guarantee of payment letters.

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Clinical authorizations

Utilizing US RNs, we offer services that will assist with the need to assess the appropriateness of the procedures that providers are requesting.

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Credentialing and provider database maintenance services

Provider research and selection, letters to providers for validation and correction of information on records and provider outreach to support provider database maintenance and updates.

Right talent profiling and training

Our stringent profiling and hiring ensures your required competencies are mapped to relevant assessment filters. Once we have hired our top-notch ambassadors, we provide them with 35+ dedicated hours of education on healthcare economics, expenditure, and the enrollment process. Then, we support our talent with 1-week foundation training, 3 weeks of process training, and 1-week nesting with 6 graded mock calls.

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Ecosystem knowledge for efficiencies and operational excellence

Sagility leverages our team of process experts with strong domain knowledge and understanding of the entire lifecycle. These claims teams and provider teams share knowledge as part of our Payer Provider Synergy effort. This group shares ecosystem knowledge to help reduce Provider Calls to our health plan partners. For one health plan client, we have leveraged this group for nearly $60,000 in annual savings. Early results like this have demonstrated the benefits of sharing knowledge and best practices from across the lifecycle, with improved TAT on payer cases, significantly reduced provider effort, and improved satisfaction

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Digital transformation for savings and CX

As an innovation hub with in-house automation and analytics experts, we deliver provider experience excellence with AI and automation, interaction analytics, digital deflection, and process re-engineering.

Our purpose-built Intelligent interaction analytics platform (IIAP) comprises customized tools via a unified dashboard, combining voice, text, and structured data, an automatic speech recognition toolkit developed in-house, and natural language processing (NLP) rules designed to analyze text and CSAT response.

Our concierge self-service engagement includes a conversational AI-bot to answer and resolve top member inquiries – expanding digital self-service with web-based chat bot, and VIVR via invisible app increasing calls resolved via self-service options. All of our digital expertise is driven by customer journey mapping, with value-stream alignment to top call drivers and sourcing of opportunities to improve up-stream and downstream processes to reduce customer effort and improve brand value.

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Cost-effective scalability and rightshoring of resources

We provide appropriate and cost-effective geographic service delivery aligned to client needs. Our business continuity program is grounded by flexible bricks-and-mortar (B&M) and work-at-home delivery models for resilience and flexibility. We can scale with an industry hub for BPO services and strong resource pool availability.

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Our healthcare accreditations

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