Payer Operations

The growing rate of change driven by new technologies and regulatory demands puts more pressure on payers to manage their core business better: winning and retaining customers, managing provider networks more effectively, and processing claims more efficiently.

Improving payer operations—with an explicit focus on creating value—is critical for driving sustainable growth. Increased competition among payers requires operational excellence, IT innovation, and flexible organizational structures. Some payers may need to streamline their operations by removing administrative layers that are creating unnecessary and costly complexity. Other enterprises may need to work on more fundamental change management, merger planning and postmerger integration, business turnaround, or profitability improvement. Still, others will need to leverage the vast advances in information technology interoperability to drive better decision-making and ultimately value.

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Health Care Payers, Providers & Services