Overview

US Healthcare industry is making transition to a digital core operating model. Through Infosys HELIX, Infosys is enabling this transition by addressing inefficiencies existing in traditional operating model and siloed enterprise software.

Aims to manage appeal and grievance modules through Infosys Payer on Cloud platform by keeping up with policies and guidelines, ensuring its smooth and hassle free handling with real-time, AI embedded , configurable processes.

Optimizing payer core administration processes for cost efficiencies and member effectiveness

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Infosys Payer on Cloud platform is a core administration platform offered as modular, independent and inter- operable functional block assembled together like lego blocks to transform payer from legacy processes to real time, cloud native, AI embedded, workflow based, configurable processes.

Appeals and Grievances module is a highly configurable cloud based platform built on AI. With real-time integration and use of AI recommendation engine, this module ensures smooth and hassle-free handling of appeals and greivances.

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Challenges & Solutions

Improve Operational Efficiency by

  • Resolving Appeals in 3 days
  • Zero missed SLAs

Reduce Administrative Cost by

  • $0 Fines and penalties
  • Lower administrative cost by 30%

Improved Member Satisfaction resulting in

  • Better NPS Score
  • Increased Member Retention