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Value-Based Risk Solutions

Health Plan Administration

We’re experts at operating successful health plans. You’ll have support with front, middle and back office solutions, from product development and underwriting, to network management, to customer service and accounting. Each functional area is tailored to the specifics of each line of business, including Individual Exchange, Small Group, Middle Market, National Accounts, Public & Labor and Medicare Advantage.

We have more than 150 years of experience in health plans and managing risk, and currently manage more than 2.8 million people in value-based care models

Third-Party Administration

Leverage our technology investments and administrative expertise, including:

New Platform that allows for faster speed-to-market and the ability to keep SG&A (Selling, General and Administrative) expenses under control. 

Consumer Tools that create a better member experience and make it easy for consumers to shop for care

Integration with provider platforms for better efficiency and member satisfaction

Risk Management

Resources to help optimize value, including:

Actuarial and Underwriting support that helps give you a competitive advantage through innovative benefit designs and pricing

Risk Adjustment expertise to ensure appropriate risk scores based on ACA and CMS regulations

Reimbursement Management that is structured to align with provider revenue cycle management processes

Plan Management

Support for:

Network Management to develop successful, clinically-integrated networks

Contract Management resources that help expedite the contracting process, reduce administrative costs and minimize financial risk

 

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