Digital healthcare operations

Solving the market need in digital operations

With increased pressures to drive down costs, increase quality outcomes, and improve member and provider satisfaction, healthcare executives are looking to digital technologies to transform their business process operations.

EXL Health takes a unique approach to digital operations. By applying AI and cloud technologies across clinical workflows, understanding client needs, and identifying opportunities for streamlining processes through automation, our clients receive scalable, customized solutions with the right level of support, at the right time.

Pairing our deep clinical domain and digital technology expertise with our industry recognized platforms, services, and solutions helps us meet clients where they are on their digital operations journey – and deliver optimized efficiencies, increased effectiveness, cost savings, and improved member, provider, and user experiences.

Providing value across the industry

EXL Health digital operations experts understand the challenges members, payers, and providers face in healthcare delivery and are well positioned to drive business outcomes that generate growth.

So how have our digital operations benefited our clients? Here are just a few examples:

  • Improved efficiencies and accuracies
  • Deliver faster AHTs/TATs
  • Decrease operational costs
  • Improve member and provider satisfaction
  • Reduced manual interventions throughout UM workflow
  • Enable clinical teams to work at the top of their licenses
  • Faster authorization review and processing
  • Eliminate/reduce administrative functions
  • Increase quality and consistency
  • Improve clinical decisions

Case study

A leading care provider’s contact center was overwhelmed with high call volumes, and needed additional support with managing appointment scheduling, cancellation requests, medication refill requests, and other time-consuming administrative processes.

Hiring was a challenge, and as the volume of requests continued to increase, patient satisfaction dropped. They needed a partner to step in with the resources, expertise, technology, and bandwidth to help solve their growing issue.

As subject matter experts, EXL Health determined the right people, processes, and technology to address the provider’s needs. Using our pool of talent, our team was able to provide additional resources necessary for success.

EXL Health digital operations 101

  • EXL Health digital operations are deployed at 3 of the 5 top healthcare insurers to automate their clinical operations.
  • Our healthcare centric proprietary and partnered conversational AI solutions can significantly reduce cost and improve CSAT/NPS through accelerated deployment, while easily integrating with new and/or legacy systems to deliver quick ROI and business outcomes.
  • We use technologies such as artificial intelligence, machine learning/NLP, robotics process automation and more to automate manual workflows and bring efficiencies and effectiveness to clinical and non-clinical teams.

Customized digital solutions tailored to fit your business goals

EXL Health’s digital operations are fully customized to solve your needs. From front office, through middle and back office services, our team of operations experts can work with your organization to plug in support where it’s needed. Our digital healthcare operations Centers of Excellence include:

Digital call center

Our digital call center services ensure member and provider satisfaction is top of mind for all health plan leaders. In order to respond quickly to members’ needs and deliver a positive provider experience, health plans can tap into EXL Health digital and automation technologies to reduce the administrative burden and deliver faster time to resolution. Proprietary technologies include conversational artificial intelligence, unified desktops, and virtual assistants that engage with members and providers to:

  • Quickly identify reason for call
  • Validate required information
  • Deliver rapid response via call transfer or call resolution

Digital utilization management (UM)

Our digital operations take standard utilization management operations to the next level by enabling UM workflows with a variety of digital technologies, including machine learning, artificial intelligence, natural language processing, predictive analytics, and more. From automated utilization review intake functions, to streamlined clinical determination with approval and/or denial, our digital technologies eliminate manual interventions and time-consuming tasks and allow our clients to:

  • Improve member and provider experiences and satisfaction
  • Meet and exceed required turnaround times
  • Standardize clinical decision making
  • Increase consistency, accuracy and efficiency
  • Improve operational and administrative cost

Today, clinical and non-clinical teams spend 30-40% of their time on administrative tasks, including working in multiple systems with multiple views and an excessive amount of data and manual lookup. When digital automation is applied, manual interventions are minimized and clinical teams members can work at the top of their licenses.

Case management

EXL Health’s case management program empowers an individualized member-centric approach to meeting the comprehensive needs of members and families to promote quality cost-effective outcomes. Our digital-first approach helps to drive transformation across case management, allowing our clients to:

  • Engage members most likely to benefit from programs
  • Optimize clinical resource scope of practice
  • Improve member engagement and health outcomes
  • Drive down health care costs across population

Pharmacy services

EXL Health’s end-to-end digital pharmacy services leverage HEDIS, STARS and Pay for Performance (P4P) quality measures to improve member care, support customer’s total cost of care objectives and deliver on contractual commitments. Using a wide scope of digital solutions, our pharmacy services can:

  • Identify and manage quality gaps in drugs, drug-disease and drug-age interactions and alerts
  • Define and measure improvement targets
  • Improve quality measures, including medication adherence, high-risk medication utilization, and inappropriate drug use

Complaints, grievances and appeals

EXL Health’s digital operations team has expertise managing the end-to-end complaints, grievances, and appeals process. Our dedicated team of nearly 300 clinical appeal, coding reconsideration, and provider resolution staff ensure a quick resolution with improved quality performance. An array of digital solutions can help our clients modernize processes and increase efficiencies, including:

  • Streamline inventory prioritization, work allocation, and status recording of processed tasks
  • Reduce compliance issues and fatal errors, minimize AHT, and improve productivity and client escalations related to letter creation
  • Store old and new process updates, provide notifications to users, decrease handling time, and increase accuracy and inventory monitoring

Get in touch

Together, let’s transform how care is delivered, managed, and paid. Visit for more information.