Business operations with speed and accuracy

Experience the difference when you unify and automate

When you work with Carelon Global Solutions, we take careful note of your goals, and then make recommendations to digitally transform how you do business.

We begin the transformation process by creating a consolidated, unified platform for your business. From here, bots, macros, artificial intelligence, machine learning, predictive modeling, and automations are put in place to:

  • Remove abrasion.

  • Help process payments and claims.

  • Quickly connect you to your data and records.

  • Enroll new members digitally.

  • Reduce late fees and interest.

  • Track inventory and service delivery.

These improvements save time and money and have the added benefit of raising compliance audit and net promoter scores.

How do we do this?

Our team has several tools and experts on hand to serve you. We offer:

Digital tools

For claims adjudication, price modeling, risk-based audits, secure live-chat messaging, value stream mapping, and additional healthcare-specific functions.

Business consulting services

To analyze proposals, verify client information, build new business opportunities, maintain integrity among internal functions, offer guidance on prospect viability, process requests for proposal (RFP), produce renewal letters, and update underwriter spreadsheet references.

A configuration management team

To conduct regular reliability checks, create built-in error detection, secure and protect all data — including health plan members’ information, and stay on top of compliance standards.

A clinical operations team

To ensure affordability, best-in-class clinical measures, and member engagement; identify fraud, waste, and abuse; and secure payments for legitimate services rendered to eligible members.

Why do we do this?

Our robust knowledge of industry and business operations solutions helps make complex healthcare processes more streamlined, so you can focus on caring for your health plan members.

The bottom line

115K+

outpatient pre-service clinical reviews

Exceptional experiences

  • Business consulting services are customized to your needs.

  • Operational solutions are scalable for businesses of any size.

  • Our one-stop call center is available for 24/5 support on topics including patient insurance eligibility, medical and dental benefits, and claim status.

Find out how you can leverage our business operations solutions for improved customer experience, operational excellence, and greater productivity.