End-to-end member management solutions drive the member ecosystem with multi-channel support of prospects’ inquiries, enrollment and transition, member care and support and retention. Our member-centric advisors take on your inbound and outbound sales to convert interest into business. Omni-channel capabilities serve members through the channel(s) they wish to be served on including proactive outreach to improve their experience.
Includes back office account setup, processing, adjudication and presentment; document management, data entry, workflow enablement, mailroom, and printing. Policy support includes premium reversals/charge backs, cancellations, payment reconciliation and beneficiary/policyholder updates. Persistency/retention includes renewal accounting, reinstatement of lapsed plans and revival accounting. Benefits management includes plan administration, additions/deletions of riders/amendments, surrenders/refunds, and maturity or survival benefits.
We provide outsourced HIPAA-compliant outsourced multi-channel contact center, technology services and transaction processing solutions, so that you can focus on patient outcomes, experience, and satisfaction. We similarly work with third-party administrators (TPAs) and pharmacy benefits managers (PBMs) to extend patient experience and enhance competitive/cost advantage. Also leverage our automation enablement, accounting, patient communications (including apps) and digital services.
Concentrix’ analytics-based assurance and knowledge-driven controllership functions provide single-point visibility into costs, resources, utilization, billing, and revenues. Our end-to-end revenue oversight includes charge capture, claim submission, coding, collecting patient balances, pre-registration, registration, remittance processing, and discharge management. Ensure the highest quality of eligibility verifications, and claims and payments processing for fast turnarounds and positive cash flows.
Entrust your claims process to us. Pre-adjudication: including processing, documentation management and data entry/correction. Adjudication: including adjudication for Medicare (PPO, HMO, PFFS), Medicaid FSA, HSA, managed care, dental, vision, behavioral, workers comp, student health, PBM pharmacy, group life, FEP claims, and local and federal compliance. Also, claims administration: including amount determination, member record updates, payment processing, claims adjustments/reporting, correspondence management, investigations and resolution, and audit support. And, post adjudication support: including data mining, overpayment reconciliation/recovery and medical cost management.
Data privacy and adherence to HIPAA, HITECH and other legislation is a priority for the healthcare industry. Our security and risk compliance organization provides advanced risk/security assessment, compliance and consulting services to help you operate with security, internal audit best practices, and process controls protecting vital patient information, supported by our HIPAA, ISO, PCI compliance and other certifications.