Healthcare payers are under pressure to reduce costs, improve accuracy, and deliver seamless experiences amid rising complexity and regulatory demands.
Sutherland combines AI, automation, and deep payer expertise to transform operations: from claims and credentialing to member engagement.
- Improved Decision-Making. Enhance decision-making with contextual insights.
- Reduced Turnaround Time. Speed up turnaround and reduce your team’s workload with omnichannel outreach.
- Reduced Operational Costs. Lower operational costs by up to 30% for large payers, regional health plans, and national PPOs.
700+
Team members Dedicated to Health Plan Member Servicing
70%
Improvement in agent productivity
2M+
Providers credentialed annually
60%+
Implementation cost savings
30%+
Lower operational costs
Case Studies
Our Solutions
Delivering seamless operations, reduced costs, and exceptional member experiences. We integrate process redesign, digital engineering, and AI embedded into day-to-day payer operations to deliver scalable, measurable outcomes.
Claims Administration
End-to-end claims processing, from intake and validation to adjudication and payment.
Member & Provider Experience
AI-enabled omnichannel support that improves engagement for members and providers.
Enrollment, Eligibility & Benefits
Streamlined enrollment, eligibility checks, documentation review, and member record management.
Population Health Management
Support for preventive care, screenings, chronic care programs, and community outreach.
Provider Lifecycle Management
Accurate provider directories, faster updates, consolidated outreach, and compliance support.
Payer & Multi-Payer Credentialing
NCQA-certified, URAC-accredited credentialing powered by automation and expert support.
Secret Shopper Solutions
Analytics-based access surveys to track availability, wait times, compliance, and experience.
Digital Health Solution for Payers
Leverage AI and digital platforms to unify payer systems and improve efficiency across operations.
Data and Analytics
Managing upgrades, feature backlogs, and complex clinical requirements with data-driven precision and speed.
Technology Services
Services that power business agility, covering end-to-end application services, from development and management to seamless migration and modernization.
Regulatory Compliance and Risk Management
We help healthcare payers navigate complex healthcare regulations and ensure compliance with industry standards by assisting them in developing risk management strategies, conducting audits, and addressing compliance gaps.
BPaaS
Operate and optimize payer workflows with AI-enabled BPaaS delivering continuous performance improvement.
Healthcare Platforms
Cross-Functional Platforms
Certifications
HiTRUST i1 Certification
Why Sutherland
Deep Domain Expertise
With 30+ years of experience and 4000+ payer domain operation experts, we are uniquely positioned to deliver measurable outcomes through our advanced healthcare payer solutions and healthcare payer services.
Cost Savings
Harnessing 15+ payer digital platforms, we can help healthcare payers streamline operations and reduce administrative overhead to reduce costs to enable competitive pricing and optimize resource allocation.
End-to-End Transformation Partner
A carefully selected set of enterprise and point solution partners across the payer value stream help deliver exceptionally engineered experiences.
Outcome-Based Engagement Model
More than 70% of our client engagements use outcome-based/TCO models, meaning we take full ownership across the entire lifecycle to deliver outcomes aligned to specific business goals.