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CLAIMS FEATURES

Work Distribution

Efficiently assigning work based on roles and resources.

Inventory Management

Real-time tracking, aging analysis, and capacity utilization.

Auto Triaging/Deep Learning

Deep learning to categorize and prioritizing incoming claims.

Target Management

Data insights enable precise goal-setting.

Optimized Workflow

Reducing manual effort and minimizing the risk of inaccuracies.

Production Forecasting

Informed decision-making and resource utilization optimization.

Production Planning & Control

Precise capacity planning for seamless resource utilization.
 
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QA FEATURES  

Sampling

Enhances the precision and reliability of quality checks within the operational framework.

Inventory Management

Tracking for automated inventory replenishment according to defined rules and capacity.

Work Distribution

Using AI/ML to allocate samples to analyze experience, line of business, costs, and other parameters.

Criteria-based Audit

Seamlessly evaluation compliance with predetermined criteria for different types of samples.

Audit the Auditor

A proprietary process that conducts multiple levels of audits at each stage.

Real-time Error Feedback

Enhances responses with automatic notifications and dynamic interactions that amplify audit precision.
 
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CSR FEATURES  

Work Summary

Summary of the previous work day so Customer Service can start off strong with an overview of their performance and responsibilities.

Call Kick-off

Structured and efficient way for Customer Service to initiate and document calls with members and providers.

HIPAA Verification

Ensuring that health-related information is accessed and shared only with authorized individuals.

Member Landing Page

Member demographic information, eligibility/claims/billing information and call history information.

Call Reason

Call documentation and categorization to help manage inquiries based on the nature of each call.

Quick Reference/Actions/Views

Real-time access to information and streamlined communications across departments.
 
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WORKFORCE CAPACITY

Adapt to Changes, Rebalance Workloads and Make Informed Hiring Decisions

Home » Capabilities » Workforce Capacity Planning

Workforce Capacity Planning

Optimize resource allocation with data-driven workforce planning to improve the effectiveness of your operations.

  • Efficiently record and report workflow elements, uncovering participant actions, locations, and transactions for alignment and transparency. Audit trails support compliance verification, improvement, and training.
  • Elevate resource oversight with integrated activity tracking, empowering supervisors with comprehensive task insights. Centralized data streamlines decision-making and optimizes resource utilization.
  • Tailor work distribution through manual selection or automated allocation, catering to various tasks and enhancing efficiency.
  • Integrating workflow insights and resource management, data-driven decisions streamline processes, boost performance, and optimize resource utilization for enhanced operational outcomes.