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Rising costs, changing mandates and new market entrants are causing healthcare payers to rethink their strategies. Health insurance carriers and issuers in both the public and private sectors are further challenged to improve operations and address the ever-rising expectations of plan members, all while containing costs.
CGI partners with healthcare payers to improve performance. From realizing greater efficiencies and improving product offerings, to increasing patient engagement and connections with providers, we help payer clients transform their operations to meet the demands of a rapidly changing landscape.
With 25+ years of experience in all sectors of the health industry, including payers, providers and government agencies, CGI’s healthcare payer solutions have benefited both commercial and government clients, as well as tens of millions of plan members. Our deep knowledge of health payer platforms, needs, and challenges uniquely positions us to help clients prepare for the challenges ahead.
We offer a comprehensive portfolio of application, infrastructure and integration services designed to improve all facets of payer operations:
- Payer administrative and information system modernization. CGI provides core administration services for commercial payers including, enrollment, premium billing, member services, claims, provider relations, printing and fulfillment. For government health plans such as Medicare and Medicaid in the U.S., CGI implements transformational solutions for numerous mission critical functions.
- Member and patient engagement portals. CGI has developed and manages numerous healthcare portals, including Medicare.gov which serves 50+ million beneficiaries.
- Claims recovery and fraud prevention. CGI’s services and software – including CAS – have helped healthcare payers recover more than $1.8 billion in lost payments due to improper claims. Our anti-fraud solutions also help payers detect, remedy and prevent claims fraud.
- Predictive modeling and analytics. CGI HEROadvisor™ is a predictive analytics and optimization tool offering optimal projections, "what if" capabilities and consistent modeling for health payers.
- Patient-centric care management. CGI offers unique solutions to improve patient care coordination by bringing together data and systems for home health monitoring and care planning, worker and ambulance dispatch, and workforce management of mobile home healthcare workers.
CGI delivers on-time, within budget solutions by following a structured methodology supported by unmatched industry experience. We offer extensive flexibility in pricing and delivery models, minimizing the need for payers to dedicate resources to stay current with evolving government policies. These models leverage our global delivery network to provide cost-effective onshore, nearshore and offshore delivery options.
Customized Audit System (PDF)
Advanced Analytics (PDF)
Enterprise planning and intelligence
CGI HEROadvisor™ (PDF)