Unlock Agile & Scalable Payer Systems for Better Member & Provider Experiences
Digital transformation has never been more critical for healthcare payers. They face rising pressure from skyrocketing administrative costs, complex and fragmented processes, and ever-changing regulatory requirements. At the same time, they must meet growing member expectations for faster, more personalized, and seamless digital experiences. Providers, too, expect simpler interactions, better service quality, and greater efficiency in managing costs.
This calls for a new approach: building AI-native, cloud-powered, digitally agile systems that deliver more innovative, impactful health outcomes.
Optimize costs, streamline workflows, and ensure compliance with:
- Enhanced employee and patient experiences. Uncover real-time, contextual insights to anticipate and address challenges with data-led analytics.
- Improved provider collaboration: Drive deeper engagement, greater efficiency, and higher satisfaction across every touchpoint of the provider journey.
- Faster and more reliable payer operations. Eliminate bottlenecks and modernize systems by leveraging operational and process efficiency.
- Accelerated time to market. Automate development processes and tasks, shorten development cycles, and reduce inefficiencies for faster delivery of health products and services.
Outcomes
Productivity improvement
Overall financial accuracy
Processing time reduction
Compliance adherence
Our Solutions
By combining deep industry knowledge and next-gen technologies, we help payer organizations build resilient, insight-rich, digitally integrated member ecosystems and digital health solutions that improve member and provider experiences.
Payer Enterprise Services
Sutherland’s Payer Enterprise Services delivers a suite of Digital Engineering Services (DES) designed to transform healthcare payer operations and drive digital health transformation through AI and cloud engineering, powering smarter operations, improved efficiency, and better outcomes.
Unified Member Data Integration and Risk Management Solution
We help payers unlock the full potential of their data. Scalable, cloud-based services unify member data across disparate systems – claims, enrollment, care management, and third-party sources – into a single, actionable view. Real-time data exchange, predictive risk scoring, and advanced analytics support care coordination, population health, and value-based initiatives.
Automated Healthcare Provider Credentialing and Compliance
We streamline provider onboarding, verification, and lifecycle management through AI-enabled automation. Powered by our SmartCred™ platform, intelligent credentialing workflows automate primary source verification, license tracking, and compliance monitoring, ensuring accuracy, speed, and regulatory alignment.
Automated Claims Intake and Pre-Processing
We accelerate claims workflows and improve accuracy across the healthcare payer ecosystem. Our AI platform-driven solution automates the ingestion, validation, and enrichment of claims data from multiple sources to ensure clean, structured data ready for adjudication. Leveraging intelligent document processing, ML, and real-time rules engines, we reduce manual effort, flag inconsistencies, and enable faster turnaround times.
Core Claims Administration Services
We support payers across the full claims lifecycle, from intake and adjudication to payment and reporting. Through intelligent automation, seamless application integration, and real-time data processing, we provide flexible, end-to-end claims administration services, and help reduce errors, accelerate processing, and improve accuracy.
Third-Party Administrator (TPA) Services
We enable TPAs to modernize operations, enhance service delivery, and scale efficiently. Using AI, cloud-native architecture and business process automation models, we support claims administration, eligibility management, provider data integration, member engagement, and compliance. This reduces administrative overhead, accelerates turnaround times, and delivers superior experience.
Foundation System Integration Services for Payers
Sutherland partners with healthcare payers to create a unified digital ecosystem that connects core administration platforms, claims systems, and emerging technologies. Through advanced integration and intelligent automation, payers reduce costs, accelerate innovation, and deliver personalized care and digital health transformation at scale.
Digital Quality Engineering and Assurance
We redefine quality for payers through a Digital Quality Engineering (DQE) and Digital Quality Assurance (DQA) framework that embeds quality engineering across the entire lifecycle. We combine agile and DevOps practices with automation-first strategies, AI-driven testing, predictive analytics, and self-healing capabilities to deliver speed without sacrificing accuracy or compliance.
Healthcare System Integration and Interoperability
We help payers achieve true interoperability by merging disparate platforms into a secure, scalable, standards-based architecture. We design integration strategies that leverage HL7, FHIR, X12, and modern APIs to unify transactions and insights across claims, eligibility, prior authorization, provider directories, and member services.
Enterprise Applications and Enterprise Resource Planning (ERP) Services
We enable payers through a holistic approach that blends modernization, cloud adoption, and intelligent automation. We work across leading ERP platforms while remaining platform-agnostic, and our capabilities span upgrades and migrations, application portfolio rationalization, workflow integration, and analytics-driven optimization for flexibility that reduces complexity and accelerates delivery.
Data and Analytics
We transform data into a strategic advantage by building intelligent, cloud-native ecosystems that enable real-time insights and agility. We create a unified data fabric that supports advanced analytics, AI-driven intelligence, and predictive modeling, empowering payers to move from reactive reporting to proactive, intelligence-led operations.
Cloud Transformation
We implement a secure, cloud-first transformation strategy purpose-built for payer operations. We facilitate end-to-end migration, modernization, and optimization of core payer systems, including claims adjudication, enrollment, provider network management, and care coordination. Our methodology embeds security-by-design principles, HITRUST and HIPAA frameworks, and advanced automation to minimize risk during migration.
Customer Experience
We provide integrated solutions that combine digital engagement, intelligent automation, and advanced analytics. We design and manage targeted campaigns for member acquisition, retention, and wellness programs, harnessing segmentation and predictive insights to deliver personalized outreach that improves satisfaction, loyalty, and health outcomes.
Intelligent Automation
We streamline processes across claims, enrollment, provider data management, care coordination, and member engagement by combining robotic process automation (RPA), AI-driven decisioning, and workflow orchestration. We embed cloud-native automation platforms and low-code orchestration tools to optimize costs and deliver predictable ROI, all while maintaining security-by-design principles and compliance with HIPAA and CMS mandates.
Platforms
Our digital reporting and analytics solution manages and analyzes large volumes of data, providing ready-to-use reports and analytical insights for more informed decision-making.
SmartHealthConnect and SmartHealthAnalyticsWe accelerate credentialing with automation, enhancing experiences, improving quality, and increasing consistency. Our interoperable, vendor-agnostic platform powers omnichannel outreach to reduce provider friction.
Sutherland SmartCred®We enable payers to streamline provider management through roster automation, inventory management, data cleansing, and validation
We provide end-to-end survey management solutions to help healthcare insurers ensure compliance, enhance patient satisfaction, and gain valuable insights into healthcare service delivery.
Survey Management PlatformWhy Sutherland
Trusted Partner to Global Health Brands
Over 35 years of healthcare domain expertise, 75 clients with multi-year partnerships with 80+ NPS. We are trusted transformation partners to iconic brands worldwide.
Industry-Leading Global Healthcare Expertise
5000+ dedicated healthcare services professionals in 15+ dedicated healthcare locations. Access specialized healthcare domain expertise, and industry best practices to augment internal capabilities.
Full-Stack Digital Engineering
End-to-end capabilities across product engineering, data platforms, infrastructure, and assurance – offering a unified and agile approach for healthcare payers.
Tailored Digital Health Solutions
200 unique inventions under several patents, 40+ AI-powered platforms, 20+ next-gen solutions, and a strong focus on building custom innovations for critical client needs.