Health Plan

The Healthcare Payor industry is experiencing an upheaval owing to change resulting from Healthcare reform, consumerism, Accountable Care Organizations and mergers and acquisitions. Factors like health insurance exchanges, Medicaid expansion, increasing Medicare population and competition from provider health plans are driving Payors much beyond their traditional financial roles. At the same time, Pharmacy Benefit Managers (PBMs) are facing shrinking margins and must build a set of distinctive services.

How Wipro Helps

At Wipro, we create and implement technology-based solutions to help Payors and PBMs navigate these industry changes and stay cost-efficient, agile and flexible.

We provide:

  • Industry-leading platform and services for Medicare enrollment, eligibility, reconciliation, submissions and appeals and grievances
  • Next generation analytics, mobility and cloud solutions to enable better business insights, member engagement and faster time to market for national plans, Blues, and mid-size commercial plans
  • Integrated infrastructure and application management services, leveraging our proven ServiceNXT platform
  • Core claims and Payor system modernization

As a one-stop services provider, we offer Payors and PBMs emerging technologies as well as support to streamline legacy platforms, applications and solutions. Our engagement models are configured for joint responsibility and we take complete ownership of solutions.

Our platforms-as-a-service or outcomes-as-a-service models include:

  • Wipro 360 Digital Member Centricity solutions:
    • Digital Member Engagement
    • Population Health Management
  • Digital Member Engagement
  • Population Health Management
  • Medicare enrollment, eligibility, reconciliation, submissions and appeals and grievances
  • Healthcare Big Data Analytics and Information Management - population health, re-admission risk, fraud, waste and abuse, Member Lifetime Value (MLTV)
  • Mobility and cloud-based health solutions and services
  • Payor back-office operations, including claims, customer service, providers, plans and benefits management
  • Retail consumer engagement solutions using mobility, analytics and cloud solutions
  • Claims legacy modernization and implementation services
  • Mail-order, specialty and retail pharmacy applications services
  • ICD 10 compliance remediation and quality assurance
  • Health insurance exchange solution and services
  • IT infrastructure Managed Services and Security Services