Health Plans

Because health plans are only allowed to keep 15% of all premiums as part of the ACA, the bottom line is more important than ever. Sutherland can help transform back-office processes with automation to improve quality and turn-around time, decrease dependency on manual processes, and increase profits. Sutherland can also help to improve the overall member experience while streamlining other operational processes, including how to attract, acquire, engage, and retain members. We can also help health plans connect disparate data sources and leverage analytics to create efficiencies and build trust.

Explore the range of Health Plans services that are available through Sutherland’s Digital, Business Process, and Customer Engagement Transformation service areas.
Digital Services

Digital Services

Design
Design thinking and journey mapping are game changers for healthcare as consumerism becomes more embedded in the industry. Revamping and transforming the member experience will become a true differentiator in healthcare’s new era as another way for health plans to differentiate themselves besides cost alone.

Analytics and AI
Sutherland’s SmartHealthSolution suite is our portfolio of analytics offerings designed to help health plans create more personalized experiences that engage members, generate insights to improve outcomes, reduce waste, optimize profits, and handle healthcare’s complex and evolving regulations. 

Customer Engagement Services

Customer Engagement Services

Sutherland can help health plans retain members and improve their overall bottom line by transforming member experience with our consumerism capabilities and inbound/outbound contact centers. Sutherland provides the type of personalized member services health plans need for their specific member population. Our 24/7,  global capabilities expertly meet health plans’ specific needs.

Business Process Services

Business Process Services

Provider Data Management
Sutherland is a proven leader in developing transformational data management solutions to the healthcare industry. Our Data Cleansing and Verification (DCAV) team recognizes the importance of accurate, up-to-date provider information and uses a combination of web-search validations and direct provider outreaches to achieve the highest accuracy in the most cost-effective and timely manner. Our credentialing services support health plans in collecting primary source verification documentation, outreach services for missing information, and provide complete credentialing packets that are ready for use.

Claims Administration
Sutherland provides high-quality and accurate claims processing transformation that eases the claims burden. By implementing automation and analytics throughout the process, we can help reduce errors and administrative costs while improving provider and member satisfaction

Finance & Accounting (F&A)
Sutherland transforms health plans’ F&A processes by leveraging industry expertise, proprietary tools, economies of scale, global delivery capabilities, and a robust service delivery framework. This helps our health plan clients to quickly drive significant value, while also providing agility and flexibility.

See Our Work.