Cognizant is the preferred technology partner of three out of the top five healthcare payers in the U.S. We also work with large-scale payers and Third-Party Administrators (TPAs). We have deep expertise with major industry applications including Facets. All of our processes are HIPAA compliant.

Our healthcare payer BPO consultants have strong credentials including NMHCC, NCHICA, and NCPDP membership; MHP, AHM and PMP certifications; and in-depth knowledge of regulatory requirements issued by agencies, such as the NCQA, HIPDB, and NPDB. We are leveraging our experience to deliver core back-office processes to healthcare payers and TPAs. Cognizant’s Healthcare BPO services include:

• Member Management Processes, covering member enrollment, group/employer set up, and proposal generation.
• Claims Administration Services, covering claims data entry, claims adjudication, claims re-pricing, subrogation, and claims cost management.
• Customer Service Administration, covering Member and Provider support.
• Network Management, covering provider credentialing, provider performance analysis, provider directory maintenance, provider set up, and maintenance.
• Accounting and Financial Reporting Analysis, covering revenue reporting and analysis, medical cost reporting, stop loss reporting, and capitation reconciliation.