What we do

Our solutions help payers refine their selection of high-risk providers while preventing and correcting improper claims payments more efficiently. We strive to engage and educate providers, instead of creating headaches for them. Audits are fewer, more targeted, and more effective, giving both payers and providers more time and resources to allocate towards member care.

Our approach has delivered proven outcomes including: increased selection hit rates, decreased false-positives, increased awareness and transparency related to pended and denied claims, appeals, claim aging and billing errors which were critical in identifying and mitigating critical provider abrasion factors.

Data Transformation & Analytics
  • Data Integration, Normalization, and Management
  • Selection Analytics
  • Provider Abrasion Analytics
  • Data Visualization
Provider Experience
  • Provider Billing and Behavior Analysis
  • Provider Abrasion Analysis
  • Provider Behavior Modification
  • Provider Gold Carding
  • Provider Intervention and Education Insights
Subrogation
  • Third Party Liability/Subrogation Services
  • Subrogation Workflow Management Software
Medical and Pharmacy Claims Auditing
  • Prepayment Solutions
  • Data Mining
  • Medical Record Review
  • Pharmacy Auditing and Analytics
  • Fraud, Waste, and Abuse Identification
  • Root Cause Analysis Services
  • Audit Workflow Management Software
Operations Optimization & Payment Capacity
  • Contract Compliance and Payment Management
  • Appeal Management
  • Special Investigation Unit
  • Coding Review
  • Performance Improvement
Why EXL
Digital Transformation. Strengthened by deep healthcare knowledge.

Healthcare payers are under pressure to remain competitive by reducing costs while improving services and health outcomes for their members. EXL helps our clients meet and exceed their goals through our deep industry expertise, advanced analytics and data assets, and powerful digital solutions to let payers know not only the best strategies for navigating the market today, but for the future as well. This comprehensive, holistic approach to reimbursement and auditing capabilities means payers can realize revenue opportunities, improve service delivery, and cut costs.

These efforts have received recognition from healthcare industry analysts; most recently we were named a Leader in Everest Group's "Healthcare Analytics Services PEAK Matrix Assessment 2019". We were also named Leader in the “IDC MarketScape: U.S. Healthcare Clinical and Financial Analytic BPO Services 2017 Vendor Assessment,” and we were positioned in the “Winner’s Circle” in the “HfS Blueprint Report: Healthcare Business Operations Services 2017.”

Leader
in NelsonHall's NEAT for "Healthcare Commercial Payer BPS" (2019)
Major Contender and Star Performer
in Everest Group's "Healthcare Payer Business
6 OF THE TOP 10
US health plans partner with us
Delivered over $1 Billion
in business value for a top 5 national health plan over the past 10 years
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