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Improving business processes across the healthcare value chain

Health insurers face growing pressure to offer improved user experiences focused on on-demand, responsive, personalized healthcare journeys for their members. As a result, the healthcare payer industry is focusing on optimizing healthcare claims processing, improving customer engagement, and combating fraudulent or erroneous payments to better serve members. By addressing these challenges, insurers can focus on the patient health and services that benefit their members, while providing a customer-centric experience free of siloed information and processes.

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$3 billion
recovered in lost payments using CGI ProperPay
~500,000
healthcare claims processed daily
10 million
members supported through medical claim engine

Providing healthcare payer optimization services and expertise with proven results

As partners to both public and private health organizations, CGI healthcare experts build, manage, and optimize business and IT solutions for our clients’ most complex and mission-critical operations.

Our deep knowledge of platforms, needs, and challenges of both healthcare payers and providers uniquely positions us to help clients prepare for the challenges ahead and achieve real transformation by addressing business and policy issues in parallel with technology. Our team of experts works with health organizations to make better, faster decisions based on more accurate and up-to-date information, resulting in improved engagement, processes, and results.

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Our healthcare payer enterprise optimization services and solutions

CRM implementation and modernization

CGI’s customer relationship management (CRM) solutions help companies create a 360-degree view of their customer base and quickly adapt to their customers’ changing requirements in order to achieve successful, customized relationships throughout the customer lifecycle. To help you implement or improve your customer relationship management systems, CGI has a team of hundreds of specialists around the world, certified to work with various CRM platforms.

Healthcare claims processing and auto-adjudication

CGI's approach to healthcare claims processing focuses on your workforce, your processes, and the best mix of automation technology. Our Robotic Process Automation (RPA) experts bring deep knowledge of leading vendor technologies (such as BluePrism, UiPath, Pega, Automation Anywhere, Kapow, and Work Fusion, among others), along with our own RPA technology, part of CGI’s proprietary Intelligent Automation Platform.

Fraud, waste and abuse prevention

CGI has been combating fraud in the healthcare market for more than 25 years. CGI ProperPay is a data-driven solution that predicts, identifies, manages, and recovers pharmacy and medical claims that have been improperly paid. It is enabling healthcare payers to prevent fraudulent activity with more reliable and repeatable results, review medical claims with the highest error rates, and, most importantly, preserve funds to focus on patient health.

How our services benefit the healthcare payer industry

Process automation

Digitalize and automate processes for accessing business-critical data sources, drive efficiencies and reduce IT burdens through CGI hosting and maintenance services

Business agility and scalability

Access a robust and continually growing inventory of services that can be configured to support your unique processes, policies, and requirements and implemented in any order

Secure and accessible

Minimize operational risks through the delivery of services from CGI’s secure data centers and the encryption of shared data

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Ready to learn more about our health services and solutions?

CGI has a rich history and deep experience in supporting the healthcare payer industry. Connect with our team to learn more about how our team of experts can support key processes and transform the customer lifecycle.