Health Care
With over a decade of experience in servicing healthcare insurance companies across North America, HGS understands the finer nuances of the industry. We have consistently provided high-quality services to these companies, helping them transform their organizations by promoting efficiencies and economies.
We have moved up the value chain to provide high-end services like plan building and payout of claims without any dollar limit. Today, our Claims Help-desk handles escalations with regard to the processes and systems from clients' own captive centers across the world.
Suite of Solutions
Marketing
- Building & Maintenance of insurance plans
- Creating & Updating Product Contracts
- Insurance Plans/Product Testing
- Up-Sell and Cross-sell of insurance plans
Pre-Adjudication
- Claims data entry (workers compensation, automobile, property & liability)
- Co-ordination of Benefits (COB)
- Claims Resolution Processing (CRP)
- Paper Referral Processing (PRP)
- ECHS Claims (Provider & Member)
- Medical Triage
- Provider Details Verification Through Calls
- Eligibility Exception Process (EEP)
Adjudication
- Claims Adjudication
- Health Maintenance Organization (HMO) - Medical, Hospital & Dental claims
- Traditional PPO - Medical, Hospital & Dental claims
- Medical Bill Review Process
- Workers Compensation
- Transfer Of Counters
- Requesting Information for processing
- Other Insurance Information processing
Post Process & Backend Support
- Overpayment Recovery Research
- Medical Claims Management/Patient Management
- Provider & Member Correspondence
- Handling Member Queries (HMO & Traditional)
- Claims Worldwide Help Desk
- Claims Audit
- Special Investigation Unit for fraud detection
Competitive Advantages
- Over 10 years of experience in providing services to US-based Fortune 150 insurance clientele
- Significant domain experience that reduces the learning curve, starting from transition to ongoing operations
- Transitioned over 65 queues since inception; over 2000 processors working in the Insurance division handling 40 million transactions, and 2 million calls annually
- HIPAA and ISO 27001 certification ensures stringent security measures
- Ability to deliver seamless transitions in less than 30 days because of readily available transition and key management team, coupled with plug and play infrastructure that significantly shortens the project implementation timeline
- Use of proprietary performance management tools to track productivity and quality besides improving processes to eliminate time wastage and enhancing overall efficiency across each project
- SMEs engaged in delivering services to clients also provide help-desk and audit services for other offshore vendors, and for the captive centers of the client