Healthcare Payer Industry

Reimagine Value-Based Care with Intelligent Automation

In healthcare payer organizations, member satisfaction is paramount. It drives everything you do and helps you stand out in a competitive landscape. Get it right the first time with AI and intelligent automation solutions that modernize your operations, accelerate claims processing, and put your members first.

Streamline Claims, Enhance Member Experience

Strategic intelligent automation helps healthcare payers overcome financial pressures and workforce challenges. Digital workers process claims and verify eligibility while digital agents tackle complex analyses. This partnership accelerates workflows, reduces manual expenses, and drives measurable results, allowing your team to focus on strategic priorities that improve member outcomes.

Efficiency Increases

0 %

Faster Turnaround Time

0 x

Reduction in Administrative Costs

0 %

Outpace the Competition: Digital Workers for Modern Payers

AI and intelligent automation go beyond streamlining administrative tasks to elevate payer operations. Digital agents and digital workers can accelerate claims processing, enhance payment accuracy, and simplify compliance monitoring, allowing healthcare payers to deliver higher-quality member experiences and more accurate provider payments. As healthcare costs and regulatory demands continue to grow, this technology becomes essential for organizations seeking to relieve administrative burden, support data-driven decision-making, and focus on value-based care models.

As claim volumes and complexity grow, so does your workload, making this technology essential for maintaining efficient member-focused operations while reducing administrative costs.

Delivering Results. Period.

Deep Healthcare Expertise

20+ years of healthcare experience across payer markets

Specialized knowledge in revenue cycle and regulatory compliance

Healthcare-first approach, not generalist consulting solutions

Proven Results & Speed

Improve efficiency by 91%

Pre-built assets available to deliver the fastest time-to-market

Ensure compliance by removing manual data entry errors

Complete Transformation Solution

End-to-end implementation from process analysis to integrated automation

Automation-positive culture development and change management

Strategic task enhancement freeing humans for higher-value work

Naviant is strong in serving highly regulated industries due to its strengths around security.

“Naviant is strong in serving highly regulated industries due to its strengths around security. It is able to effectively comply with strict data privacy restrictions that large public institutions have by having good experience around things like data encryption and providing role-based access.”

Vice President

Healthcare BPO Customer

Key Benefits of a Digital Workforce

Key Automation Benefits for Healthcare Payers

From data entry to decision-making, transform your Payer Operations. Streamline your administrative workflows with intelligent automation solutions. Picture an operation where your staff isn’t buried in manual claims verification, and your members receive prompt, accurate responses to their inquiries. It’s within reach when you implement automation for repetitive tasks and leverage the capabilities of an AI-driven digital workforce for functions that drain your team’s potential.

Accelerate Claims Processing

Digital workers handle validation, coding verification, and adjudication simultaneously, eliminating processing bottlenecks that frustrate both members and providers.

Enhance Member Experience

Automation facilitates real-time eligibility verification and personalized communication, reducing member inquiries. Members receive faster responses, accurate explanations of benefits, and streamlined prior authorizations, converting traditionally frustrating interactions into seamless digital experiences.

Significant Cost Reduction

Healthcare payers implementing digital workers and agents can achieve up to a 90% reduction in administrative costs while processing higher claim volumes. Automation eliminates expensive manual processes, reduces payment errors, and allows reallocation of resources to higher-value strategic initiatives.

Strengthen Compliance & Accuracy

Intelligent automation ensures consistent application of the latest regulatory requirements and payer policies, reducing compliance risks. Rules-based engines and AI validation detect potential issues before they become costly violations or payment inaccuracies, creating audit-ready operations.

Customer Story

Healthcare Payer Speeds Processing by 72% With ECM

The Government Health Administrators (GHA) division of Wisconsin Physicians Service Insurance Corporation (WPS) revolutionized its processes with advanced workflow technology. This technology helps provider enrollment staff complete work in 17 days, compared to the 62 days it used to take – a 72% improvement.

Discover the Impact

How to Use It

Apply Intelligent Automation & AI Agents Across Your Entire Operation

Our tailored automation solutions eliminate claims processing backlogs, accelerate provider approvals, and reduce costly errors that impact both compliance and member satisfaction. Begin with one critical workflow, like claims processing or care gap analysis, and watch efficiency ripple across your entire organization. Your team drives the pace as automation helps overcome workforce challenges and transforms how you deliver value.

Areas to Automate

Member Enrollment
Claims Management Processing
Prior Authorization Processing
Member Communication Management
Claims Settlement & Adjudication
Health Claims Extraction (EDI 837/835)
Intelligent Document Processing (IDP)
Intelligent Mailroom Service
Integration to Core Systems
Robotic Process Automation (RPA)

Member Enrollment

Intelligent automation lets you improve customer satisfaction, lower your costs, and ensure a smooth transition for your new customers.

Automate Member Enrollment for better customer satisfaction
Collect customer information, verify identity, and perform background checks electronically.
Create customer profiles and accounts in the CRM system.
Send welcome emails and onboarding materials to new customers.

Claims Management Processing

Case management provides 360 degree visibility into a claim. From first notice of loss through investigation and close, you’ll have all the information you need in one place to make better, faster decisions.

Brings disparate data into one system to provide a 360-degree view of the “case”
Quickly redistribute work by authority level, skills, claim type, or other business rules
Visibility into the process allows managers to prioritize the most important work first
Automatic notices for missing information keeps the process moving

Prior Authorization Processing

Optimize the tedious prior authorization process with AI-driven technology that speeds up the audit process, increases accuracy, and ultimately impacts making a better decision.

Improve decision-making with more accuracy
Accelerate audit process to make better faster decision
Save money by optimizing a tedious, error-prone process and stop overpayments
Reduce time spent on reconsiderations (appeals and grievances) due to errors

Member Communication Management

Effortlessly assemble content to create personalized customer communication with integrated intelligent automation technology.

Improve customer satisfaction while lowering cost of assembly
Increases consistency and accuracy of communication
Support compliance for corporate or regulatory standards
Repurpose your team’s time to focus on high-value tasks

Claims Settlement & Adjudication

Streamline claims processing by automating key adjudication and settlement tasks, reducing errors and ensuring compliance:

Automate the verification of policy details, coverage limits, and claim information
Implement predefined criteria to automatically flag claims that require further review
Determine settlement amounts, then issue payment instructions
Generate adjudication reports and settlement statements
Track and update claim status in the system

Health Claims Extraction
(EDI 837/835)

Automate claims extraction CMS-1500, UB-04, and Dental Claim (ADA) with intelligent document processing. End-to-end automation speeds up the process and eliminates the risk of human error.

Classify, extract and export health claims data into EDI 837 with customizable rules and formats
Accurately extract complex data with intelligent document processing (IDP)
Upload claim, extract and validate data, and export in EDI 837 or directly integrate
Securely extract data and say goodbye to time-consuming manual data entry

Intelligent Document Processing (IDP)

Automate the classification, extraction, validation, and archiving of data from various document types using intelligent document processing (IDP).

Digitize paper documents and store in a searchable database
Automatically categorize and tag documents based on content
Route documents to appropriate departments or individuals for approvals
Generate summaries and extract key information for easy review

Reconsiderations (Appeals & Grievances)

With documents coming from all sources –portals, emails, faxes, and mail – managing the A&G process is no small task. Our solutions provide end-to-end automation for this complex compliance challenge.

Manage deadlines, expedite urgent appeals, and provide real-time reporting
Track all documentation, regardless of source, according to CMS rules
Provide real-time process insights so you can make better faster decisions
Support compliance with detailed audit trail

Integration to Core Systems

Unlock the power of integration with your core systems to speed up processes and keep workers in the systems they love. We are experts, let us show you how.

Industry-specific (Guidewire, Duck Creek, LifePro, etc.)
Allow users to stay in your core systems like Workday, SAP, Oracle, JD Edwards, Microsoft, etc.
Surface critical content in real-time to increase customer satisfaction
Enable seamless access to critical documents and data in Salesforce

Robotic Process Automation (RPA)

Speed up document processing and compliance monitoring with RPA. This intelligent automation technology automates repetitive rule-based tasks, improves efficiency, and reduces errors.

Process Automation | Bots complete repetitive tasks at rapid speed with capabilities like cross-check, auto-alerts, site logins, etc.
Finance | Review invoices, POs, and bills and perform ERP/CRM lookups
HR & Purchasing | Confirm form completion and validate backgrounds
IT Help Desk Automation | Reset passwords, answer questions, onboarding tasks, etc.

Discover What Intelligent Automation Can Do For You and Your Members

Let our experts guide you toward the right solution to improve your processes, empowering better outcomes for all.

Let’s Talk

Customer Stories

Every Success Story Starts With a Vision

Our customers inspire us every day. It’s our privilege to help them achieve their goals and reimagine what’s possible.

View More Customer Stories

Naviant was the only vendor we evaluated that could quickly address our specific use case, migrate content, and automate repetitive processes in a robust fashion.

“Naviant was the only vendor we evaluated that could quickly address our specific use case, migrate content, and automate repetitive processes in a robust fashion; they have experts who are familiar with insurance, which helped speed up and streamline implementation.”

Chief Information Officer

Healthcare Customer

Technologies

Building The Bridge Between Now & Next

Our deep consulting and technical expertise helps us build solutions that automate your most time-consuming work. We combine Intelligent Automation tools in unique ways to help you reimagine work to solve your most complex problems and deliver exceptional outcomes.

Learn More About Our Technologies

Why Choose Naviant?

Your vision is our priority. We start by understanding your goals and discovering the right path forward together with a process-first approach. This collaborative approach helps us design solutions that automate the highest-impact processes and tasks, drive operational excellence, and build lasting success.

See Why Organizations Choose Naviant

Naviant has deep industry expertise in markets like insurance and healthcare.

“Naviant has deep industry expertise in markets like insurance and healthcare. They know how to integrate ECM with healthcare platforms like EMR and design insurance-specific workflows like claims management.”

Executive