Enrollment Management

Improving Group enrollment performance requires insight. With comprehensive account visibility, intelligent workflows and collaborative tools for brokers and customers, health plans remove operational constraints, thereby reducing costs and accelerating quote to card.

• Onboard groups in a matter of hours
• Enable self-service capabilities for member coverage maintenance, corrections and audit discrepancy reviews
• Monitor expected transmissions or upload enrollment files outside of schedule

Limited transaction visibility into enrollment operations can damage market reputation and lead to large amounts of membership churn. Leveraging marketplace-specific business rules, discrepancy reconciliation, and real-time transaction detail, allows health plans to focus on capturing a growing market.

• Validate inbound and outbound transactions against Exchange published standards, including non-834s
• Reconcile expected and paid subsidies, generate financial dispute reports and process financial dispute responses
• Reduce manual intervention and processing spend through automation and intelligent workflows, resulting in lower cost and less data errors

With intelligent workflows, financial reconciliation, and actionable visibility, MCOs gain new confidence in regulatory compliance while reducing operational costs.

• Streamline compliance with constantly changing state-specific rules and regulations
• Identify missing members and dis-enrolled members through comparison of roster details
• Centralize data validation and mapping with intelligent workflows

With increased confidence in regulatory compliance, system scalability, and reduced manual intervention, MAOs can establish a competitive advantage.

• Enable real-time status tracking and intelligent workflow processing
• Drive expedient processing and delivery of confirmation letters to applicants
• Automate upfront data validation and system-wide orchestration