Healthcare Payers Industry Overview

Healthcare payers are in a state of flux. Many healthcare and pharmaceutical companies are choosing business process outsourcing (BPO) providers to manage select functions, such as customer service, back-office workflow, claims administration, and data management. Healthcare payers who partner with BPO service providers like Sutherland leverage the strategic advantage of an integrated BPO solution with unparalleled experience and expertise in healthcare management business services. Our integrated business services help healthcare payers provide outstanding customer experiences, maximize operational efficiency, and minimize their medical loss ratio.

New legislative and regulatory mandates are forcing healthcare companies to reduce operating costs. At the same time, they are challenged to improve benefits coverage, raise customer satisfaction levels, and shift from a disease management approach to a wellness strategy. These changes will benefit members by improving population health and ensuring quality customer service.

Payers will net positive results, too, as this new strategy requires them to:

  • Reduce administrative costs and capital expenditures
  • Integrate multiple systems
  • Gain access to skilled resources
  • Ensure business continuity
  • Improve information accuracy and availability
  • Strengthen shareholder value

To accomplish these objectives, payers are evaluating strategic alternatives to help them align and improve their per-member, per-month revenues and expenses. Sutherland can help you reach these objectives.

Sutherland's BPO services for the healthcare payers industry include:

Member Acquisition

  • Enrollment, Open Enrollment
  • Government Members
  • Regulatory Compliance, OEV
  • Employer Groups

Member Care

  • Member Relationship Management
  • Maintenance and Retention
  • Policy Management
  • Eligibility

Provider Care

  • Credentialing
  • Patient Information
  • Coverage Information
  • Provider Outreach

Back Office

  • Capture, Data Entry, Hosting, Workflow
  • Claims Administration, Adjudication Platform, Services
  • Gateway, Portal
  • Information Exchange

KPO Resources

  • Case Managers
  • Allied Health Professionals
  • Customer Service Advocates
  • Adjudicators
  • Telemedicine

Business Intelligence

  • Data Aggregation, Mining
  • Fraud Detection, Prevention
  • Wellness

Outcomes Management

  • Wellness
  • Disease Management
  • Utilization Management
  • Formulary Management
  • Case Management