Health & life sciences
Health & life sciences
Together, let’s transform how care is delivered, managed, and paid
Health & life sciences
Together, let’s transform how care is delivered, managed, and paid
Human Ingenuity is our catalyst
We believe in the power of Human Ingenuity – our innate ability to work together with our clients to improve outcomes, optimize revenue, and maximize profitability. By combining our customer-centric approach, our domain expertise, data and analytics, and proprietary technologies, we make healthcare transformation happen.
We do this through our value-added capacity, technology and analytic-enabled solutions, and insight and advisory services.
Who we serve
Together, we work with clients across the healthcare ecosystem to meet their current and dynamic business challenges.
Pharmacy Benefit Managers
Health solutions
Digital services
Digital innovations that transform how healthcare is delivered, managed and paid.
Life sciences
Together, let’s get the right treatment to the right patient at the right time
Provider finance & accounting operations
Partnering with healthcare providers to drive growth and profitability.
Risk adjustment & quality
Industry-leading and KLAS recognized risk adjustment and quality expertise
Latest insights
Transformation starts with inspiration. See the
latest ideas from some of our leaders.
Case study
Cognitive AI solution transforms contact center for lead...
Case study
Cognitive AI solution transforms contact center for leading healthcare organization
Cognitive AI solution transforms contact center for leading healthcare organization
The challenge
A leading healthcare organization was looking to improve its providerfocused contact center operations for precertification processing. After an in-depth assessment of their operations, which included the types of calls, call volumes, average handle time, and provider satisfaction, the organization identified several areas of challenge, including
Cognitive AI solution transforms contact center for leading healthcare organization
The challenge
A leading healthcare organization was looking to improve its providerfocused contact center operations for precertification processing. After an in-depth assessment of their operations, which included the types of calls, call volumes, average handle time, and provider satisfaction, the organization identified several areas of challenge, including
Case study
Enhance provider experience with EXL’s data-led, digital...
Case study
Enhance provider experience with EXL’s data-led, digital provider portal and automated calling platform
Healthcare providers that rely on traditional methods for medical record submission like mail, copies, faxes, and other methods for medical record (MR) submission are losing potential revenue opportunities while placing valuable-payer partnership at risk. Manual processes are slow to complete and prone to error, as they require high levels of rework and often end up with records lost within the submission workflow due to miscommunication on status and miss
Healthcare providers that rely on traditional methods for medical record submission like mail, copies, faxes, and other methods for medical record (MR) submission are losing potential revenue opportunities while placing valuable-payer partnership at risk. Manual processes are slow to complete and prone to error, as they require high levels of rework and often end up with records lost within the submission workflow due to miscommunication on status and miss
Case study
Digitally-enabled data mining approach expands scope of ...
Case study
Digitally-enabled data mining approach expands scope of audit opportunities
Customer-centric payment integrity program achieves significant savings for major U.S. healthcare payer
The Challenge
A major U.S. healthcare payer was seeking improved results from its payment integrity program, specifically its data mining practice. Unlike a clinical claims audit that challenges how a provider billed a claim, data mining is used to determine if a claim was paid correctly.
There are many ways that a payment can be incorrect. Up
Customer-centric payment integrity program achieves significant savings for major U.S. healthcare payer
The Challenge
A major U.S. healthcare payer was seeking improved results from its payment integrity program, specifically its data mining practice. Unlike a clinical claims audit that challenges how a provider billed a claim, data mining is used to determine if a claim was paid correctly.
There are many ways that a payment can be incorrect. Up
Infographic
Digital Healthcare Operations: Case management
Infographic
Digital Healthcare Operations: Case management
Reduce administrative tasks so case managers can focus on providing care
In today’s healthcare environment, clinical and non-clinical teams can spend more than one-third of their time on administrative tasks as part of the case management process. This work often requires accessing multiple systems and an excessive amount of manual tasks. Applying additional non-clinical or clinical staffing, and digital technology solutions, such as AI and automated co
Reduce administrative tasks so case managers can focus on providing care
In today’s healthcare environment, clinical and non-clinical teams can spend more than one-third of their time on administrative tasks as part of the case management process. This work often requires accessing multiple systems and an excessive amount of manual tasks. Applying additional non-clinical or clinical staffing, and digital technology solutions, such as AI and automated co
Solution sheet
EXL Health Pre-Payment Auditing Services
Solution sheet
EXL Health Pre-Payment Auditing Services
Payment integrity programs are moving beyond a post-payment approach to identify billing and payment anomalies before claims are paid. By shifting payment integrity audit activities earlier in the claims-adjudication process, payers achieve improved efficiencies, greater insights, and higher savings through improper payments prevention, without upsetting the claim adjudication lifecycle.
Leverage digital technologies to deliver speed and accuracy
Thr
Payment integrity programs are moving beyond a post-payment approach to identify billing and payment anomalies before claims are paid. By shifting payment integrity audit activities earlier in the claims-adjudication process, payers achieve improved efficiencies, greater insights, and higher savings through improper payments prevention, without upsetting the claim adjudication lifecycle.
Leverage digital technologies to deliver speed and accuracy
Thr
Case study
Innovation during pandemic results in successful virtual...
Case study
Innovation during pandemic results in successful virtual pharmacy audit program
Challenge
Pharmacies play a critical role in keeping communities healthy. When the COVID-19 pandemic hit, pharmacies needed to take special measures to protect their customers and staff, including limits on who was allowed onsite. These adaptations impacted pharmacy audits, which are essential to cost containment, overpayment identification, and compliance.
In 2020, our client, a large national pharmacy benefit manager (PBM), came to us looking for a
Challenge
Pharmacies play a critical role in keeping communities healthy. When the COVID-19 pandemic hit, pharmacies needed to take special measures to protect their customers and staff, including limits on who was allowed onsite. These adaptations impacted pharmacy audits, which are essential to cost containment, overpayment identification, and compliance.
In 2020, our client, a large national pharmacy benefit manager (PBM), came to us looking for a
Why EXL Health
Applying our expertise in AI, analytics and cloud, we make sense of your health-related data, enabling you to improve outcomes, optimize revenue, and maximize profitability across the care continuum. Our digital dexterity and Human Ingenuity are the catalysts to solve complex healthcare problems.
We accelerate your ability to transform how healthcare is delivered, managed and paid. We amplify how quickly, efficiently and affordably you deliver quality care—enhancing your performance with nimble, scalable solutions.
Together, we will do this.
6,000+
Healthcare professionals including 2,100+ clinical resources
300+
Coding and claims experts
260+ million
Unique life touch points
550+
Data scientists
1,000+
Employer groups represented
8 of the top 15
life sciences companies
6 of the top 10
US payers
2 of the top 3
PBMs
Leader and Star Performer in Everest PEAK Matrix
Best in Class in Aite Matrix
Gartner Peer Insights Customers’ Choice
Best in KLAS
EXL in the news
Accreditation and certification
Philippines (HealthCare)
Philippines (Workers Compensation)
US (Certificate Number: 20.04.34)
Philippines (HealthCare)
US (Utilization Management)
US (Case Management)