Enrollment
Management

There are a variety of challenges that can impact payers’ enrollment management operations, including:

• Fragmented data in nonstandard formats
• Using multiple channels and systems for enrollment updates
• State-specific nuances
• Detecting changes to enrollment information files
• Poor error handling and slower enrollment times
• No interoperability between systems
• Overreliance on manual workflows that hinder scalability

Manually managing enrollment data requires a significant investment of time and resources. In addition, manual workflows are more likely to lead to errors, which create processing delays, slow enrollment times, and negatively impact the member experience.

By leveraging AI to highlight errors for manual review and perform batch error correction, health plans can significantly reduce administrative workloads and deliver much-needed support to their administrative teams.

The right technology solution can help health plans overcome their biggest challenges in enrollment management. When evaluating potential enrollment management solutions, health plans should consider five key factors:

• Functionality – Does the solution do what you need it to do?
• Compatibility – Is the solution compatible with internal and external systems?
• Security – Does the solution offer preventative controls and audit trails?
• Scalability – As your business grows, will the solution be able to grow with it?
• Maintenance – How much time/resources are needed to maintain the solution?

For a deeper dive into the keys to selecting an enrollment management solution, read our blog post on the topic.