Improve Health plan member retention by leveraging AI & Automation

The recent push towards consumerization in Healthcare requires Health plans to transform themselves to provide high grade member experiences. Further, they might have a diverse array of manual processes which could lead to sub-optimal member experiences which eventually impact revenues.

CitiusTech can help Health plans drive personalization, informed decision making and automation across the enterprise ultimately improving member care journeys using services such as Amazon Pinpoint, AWS Services-Based API Factory Model etc.

Areas of Focus:

• Recommendation Engines: Personalized shopping experience for health plan members based on member historic data to recommend benefit packages using AWS EventBridge SNS, SES services etc.

• Conversational AI solutions : Improved call center operations by integrating smart chatbots with in-house systems using services such as Amazon Lex, Amazon Rekognition, Amazon SageMaker, Amazon Comprehend etc.

• Streamline workflows: Re-engineer processes for claims and underwriting for faster claims error resolution & prior-auth determination using AWS API Gateway, IAM, CloudWatch, CloudTrial etc.

Key Benefits: Reduce operational cost, Greater net promoter score, Higher member retention, Higher compliance measures rating, Improved member outcomes

Accelerators:

Embedded Intelligence: AI Engineering, Hyperautomation, MLOps

RPA: Business process automation & management

Case Study: Enabled leading Nonprofit Insurance Organization drive vision for client's Digital Health Solutions by developing a prototype of plan recommendation engine to recommend personalized health plan option suitable for member’s needs. The client was able to achieve $2.5K average OOP cost savings per member per year and 150k+ ACA health plan members benefited

CitiusTech's Payer vertical is focussed on delivering specialized solutions and services across the healthcare digital value chain - spanning interoperability, data & analytics, digital engineering, provider performance management and member experience management.