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Healthcare – Payers

Maximize member enrollment and retention through insight-driven processes

Case Study

Cloud Environment Setup

Set up a data warehouse for combined entity and report generation

Home Industries Healthcare Healthcare Payers

Healthcare payers across the board are primarily struggling with two major challenges – cost and quality. To adapt, evolve, and stay relevant, payer businesses today need digital transformation at all levels. We provide future-ready solutions that help payers evolve quickly in the face of new challenges – whether it is emerging care and payment models, realignment of incentives, or rapid changes in industry technologies.

With over 20 years of experience, we help healthcare payers turn these challenges into opportunities. We’ve worked with leading industry players to support sustainable revenue growth, enhance customer experiences, and improve quality of service.

Leverage value-oriented innovation that can ride through complex government policies, compliances, and fierce competition.

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Payer Segments We Serve


Health Plans

Value-based solutions for health plan providers


Managed Care

Provider-payer collaboration organizations



Government-sponsored payers and community programs



Self-funded and fully insured third-party administrators


Specialty Payers

Payers covering dental, vision, mental health, and other specialties

We bring next-generation digital technologies to help payers reduce turnaround times for approvals and claims payments, deliver customer-centric experience, and drive enhanced healthcare value through improved operations.

Administrative processing systems
Core Modernization

Get faster and highly efficient core administrative processing systems

Mobile solutions to improve productivity and engagement
Mobile Solutions

Boost productivity, drive member engagement and improve user experience

Seamless data integration with providers
Data Integration

Easy access to valuable data across the value chain with seamless integration

Power of analytics to improve member enrollments & retention
Data Analytics

Harness the power of analytics to improve member enrollments & retention

Pre-built modules for enrollments, billing, portals & BI
Frameworks and Modules

Pre-built modules for enrollments, billing, portals & business intelligence

Risk management and compliance programs
Risk Management & Compliance

Drive growth with data-driven risk management and compliance programs

Unleash Technology-driven Innovation across the Value Stream

The conventional reimbursement models in the healthcare industry are fast-evolving to value-based models. The focus is on ensuring mutually beneficial healthcare cost management solutions.

ACS Solutions is at the forefront of designing and implementing cost reduction and containment solutions. We help healthcare payers reduce overutilization and quickly identify areas where healthcare spending can be minimized. All of this, while staying compliant and enhancing transparency.

How can we help?

  • Robotic Process Automation of Enrollment, Claim Appeals Management
  • Risk Adjustment of Medicare, Medicaid, and Commercial Claims
  • Hospital Readmission Prediction and Reduction
  • Proactive Interventions Management
  • Telehealth Platform Implementation
  • Chatbots for Manual Support Reduction
  • On-Premise to Cloud Data Migration
  • Cloud Cost Optimization
  • Claims Fraud, Waste, Abuse Management

Robust digital health ecosystems help deliver quality despite the fast-changing and growing demands of the industry. These ecosystems empower payers to optimize their healthcare delivery by utilizing previously unavailable information to develop more meaningful offerings.

At ACS Solutions, we help global payer organizations across the board drive member enrollments and improve customer experience through a range of offerings.

How can we help?

  • Care Management
  • Utilization Management
  • Disease Management
  • Patient Risk Profiling and Stratification
  • Value-based Payments Administration
  • HEDIS and Star Ratings Data Management
  • IoT Device Integration
  • Data-backed Clinical Decision Support

Today, healthcare payers need a back-office that can seamlessly power their front office. We work with payer organizations to develop intelligent operations. These specific technology frameworks are designed to identify and address gaps in capabilities and processes quickly.

At ACS Solutions, we combine the power of state-of-the-art technology architecture, agile workforce, intelligent automation, and advanced analytics to drive exceptional business results.

How can we help?

  • Provider Contract Management
  • Claims Validations and Submission to State/CMS and Error Correction
  • EDI Format Data Management
  • FHIR-based APIs for Patients and Providers
  • Multiple Vendor Data Management
  • Administering Provider, Member, Claims, and Contract Related Databases
  • Generating Highly Impactful Dashboard Visualizations and Reports
  • Member Enrollment Platform for Medicare and Commercial

Deliver a Well-Coordinated Value-Based Healthcare Experience Through High-Impact Technology Transformations

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