We specialize in healthcare payer operations, and our team has years of experience working directly with many of the largest healthcare payers in the country. Within our industry focus we cover the entire breadth of healthcare operations:

Functional Areas

Member-Based Services

• Customer service
• Enrollment
• Premium billing
• Associate training
  

Provider-Based Services

• Customer service
• Credentialing
• Contract management
• Associate training

Claims

• Claims processing
• Claims adjusting
• Claims auditing
• Recoveries
  

Systems & Database Maintenance

• Benefits configuration / plan building
• Provider maintenance, data cleanup
• Business analysis & troubleshooting

Systems Experience

Commercial

• Facets (Trizetto)
• QicLink (Trizetto)
  
• QNXT (Trizetto)
  
• QMACS (Trizetto)
  
• Plexis
  
• xpress (HealthTrio)
  
• NASCO
  
• MetaVance (EDS)
  
• Diamond (Perot)
  
• AMISYS Advance (DST)
  
• PowerMHS (DST)
  
• PowerSTEPP (DST)
  
• MHC (DST)
  

Medicare

• MCS
• VMS
• FISS
  
• APASS

Our experience translates into faster ramp-up, higher productivity, and higher quality for our clients, which drives bottom-line results.