Health Plans & Payers
Driving business and clinical value realization
through operational efficiency, care optimization
and reimagined member and provider experiences.
How We Work with Health Plans
In the dynamic healthcare industry, financial performance is crucial for the sustainability and growth of payers. Genzeon understands the unique challenges faced by healthcare payers in managing costs, improving revenue streams, and enhancing operational efficiency.
Our tailored solutions are designed to address these challenges head-on, helping you achieve significant improvements in financial performance.
We leverage advanced analytics and data mining to identify cost-saving opportunities, streamline claims processing, and reduce administrative overhead. Our expert consultants work closely with your team to analyze data, uncover hidden patterns, and develop strategies that optimize reimbursements, minimize fraud, waste, and abuse, and enhance risk management. With Genzeon by your side, you can make informed decisions that drive profitability while ensuring regulatory compliance.
Outcome-as-a-Service
Genzeon aligns our success with yours, resulting in better care. We own outcomes not deliverables—a business model we refer to as outcomes-as-a-service (OaaS).
Health Plan Use Cases
Bill Review Automation
Automate processing of healthcare claims submitted in non-standard formats to replace existing 3rd party OCR Bill review system with a new product owned by the client.
Digitization
Simplify health data exchange with business partners and data providers (HIE/EHR) by providing timely and secure access to health data in a coordinated manner for all partners.
Virtual Assistants
Evaluate potential for emerging VA technology to improve clinician satisfaction and workflows by implementing a prototype to demo and plan for potential expansion in other key workflows.
Medicare Analytics
Review current program performance, member satisfaction, and competitor benchmarking for optimal plan performance ratings and incentives.
Physician Documentation Automation
Implement clinical conversation assistant to reduce physician fatigue by automated charting of patient–physician encounters, relieving physicians of most of their administrative burden and increasing productivity and job satisfaction.
Digital Maternity Care Management
Digitize pre-admission medical questionnaire for newly launched Maternity Care Management Program with a target go-live of 2 months.
Strategic Automation to Real Value
Recently, Becker’s Hospital Review and Genzeon leaders conducted a webinar detailing how Genzeon can help healthcare organizations avoid stalling their digital transformation progress and accelerate their value.
Watch the clip here where Kali Durgampudi, CTO of Zelis, explains how automation has addressed the need for optimization with larger financial volume with an increased shortage of talent.
Why Choose Genzeon?
Domain Expertise
Genzeon possesses deep domain expertise in healthcare payer operations, regulations, and market dynamics. We understand the unique challenges faced by payers and tailor our solutions to meet your specific needs.
Innovation-driven Solutions
We stay at the forefront of technological advancements, leveraging artificial intelligence, machine learning, and robotic process automation to deliver innovative solutions that drive operational excellence and improve outcomes.
Collaborative Approach
At Genzeon, we believe in forging strong partnerships with our clients. We work collaboratively with your team, ensuring a seamless integration of our solutions into your existing workflows, and provide ongoing support to ensure your success.
Security and Compliance
We prioritize data security and compliance, adhering to industry best practices and regulatory guidelines. Our robust security measures safeguard sensitive information and ensure that your operations remain HIPAA-compliant.
Regulatory Compliance
Partners
Let Genzeon help you stay compliant with ever-changing
state, federal, and industry regulations.
Meet with the Genzeon Healthcare Team
As the General Manager of Healthcare, Harsh is responsible for leading the Genzeon healthcare practice. Prior to Genzeon, Harsh has spent 20 years focused on removing inefficiency by utilizing technology, process and business model innovation in healthcare with leadership roles for Fortune 500 companies and SaaS startups, including Aetna, Anthem, and crankfrog. He is dedicated to creating value for our healthcare clients, driving ROI through technology and process innovation.
Vikram Pendli is our Chief Technology Officer (CTO) for Genzeon. He is responsible for Genzeon’s technology strategy and solution architecture initiatives. Vikram’s primary focus is helping clients build a digital roadmap to transform their businesses. As an industry consultant, he has deep expertise in designing, developing, and architecting cloud solutions for Public Clouds (Azure and AWS) and Hybrid Clouds. He has complete exposure to Azure cloud services, including PaaS, IaaS, Storage, Business Analytics, Virtual Networking, Data Analytics, Artificial Intelligence, and Machine Learning.
Prashant leads the Genzeon Intelligent Automation practice. He has 20+ years of experience as a technology leader with 18+ years in the healthcare industry. Prior to joining Genzeon, Prashant spent 15+ years at Anthem where he held multiple leadership roles including leading the Automation COE. Prashant has an MBA from Yale School of Management with a concentration in healthcare.
Global business development and delivery management in Business and Technology Consulting services.
Specialties: Fortune 500 Client relationship management; Experience across multiple industries including Banking and Financial Services; Healthcare; Manufacturing; Entertainment, Automotive. Entrepreneurial experience in Datawarehousing/ BI services.
Transformation Agent/ Change Ambassador; Staunch supporter of Women Empowerment
Specialties: Fortune 500 Client relationship management; Experience across multiple industries including Banking and Financial Services; Healthcare; Manufacturing; Entertainment, Automotive. Entrepreneurial experience in Datawarehousing/ BI services.
Transformation Agent/ Change Ambassador; Staunch supporter of Women Empowerment
With 19+ years of experience managing global delivery models, Pranita specializes in driving digital transformation, managing large-scale transformations, and delivering business process automation for healthcare clients.
Her expertise extends to various areas, including Account Management, Client Engagement, Business Development, Program Management, and Application Development. Pranita excels at navigating all levels of the organization, thanks to her strong interpersonal and communication skills. She's a trusted and strategic partner to Genzeon's clients, helping them grow and manage key accounts by building strong client relationships, delivering value, and driving profitability.
