Member Enrollment, Onboarding and Maintenance

Automate member enrollment. Improve Provider Data Accuracy. Reduce Costs.
Mitigate Compliance Risk. 

Member enrollment, the first step in the Member Servicing cycle, is a critical business process that is often fraught with numerous errors and irregularities, due to paper-based, manual processing. This leads to the process often becoming frustrating for the prospective member, and time consuming and costly for the payer.

Challenges Faced

  • High turnaround time between submission and approval of an application
  • Manage Open Enrollment period
  • Significant error rates in application processing
  • Inefficient use of staff with a significant amount of staff time wasted in managing administrative tasks
  • Lack of a robust tracking mechanism to monitor each application through the enrollment life-cycle leading to high loss rates for applications
  • Difficulty in managing applications tracking sheet and orphan documents
  • Complex business logic for processing member enrollment business process
  • Ineptness to effectively and efficiently handle exceptional cases
  • Analytics for usage of different communication modes and viewership of marketing messages

Benefits

  • Quick turnaround time. Improve the time taken to adjudicate the claim

  • Improve Accuracy. Reduce errors through robust quality assurance processes and seasoned claims adjudicators

  • Strong Governance processes. Our robust governance processes ensure that you are always in control with detailed reports on claims inventory, and service level commitments.

  • Reduces costs associated with claims processing by as much as 30-40% through our deep global delivery model