Our reputation of providing the right expertise with the highest level of customer service has earned us the right to extend our offerings beyond technical staffing to team services, component and even workforce management services. You see, we believe that when you have the right people with the right skills, background, and professionalism, you can easily achieve your goals. Organizations must continuously innovate and transform themselves to stay ahead of competition. Sky Solutions helps enterprises stay agile and respond better to changing market conditions by optimizing business processes, making their IT infrastructure resilient, and ensuring faster business results.
Healthcare Appeal & Grievance Maintenance
With healthcare reforms leading to increased enrollment for Medicare coverage, disputes over coverage or payment are bound to rise. As members have the right to appeal any decision about their Medicare services, payers need to have a comprehensive system to address concerns and comply with regulatory requirements. Implement a real-time workflow including intake and distribution of highly sensitive Complaints, Appeals & Grievances. Provide configurable workflow templates for rapid data entry, automated validation and standardized data collection. Use standard productivity, activity, and operational reports for managing the work. Utilize complex executive decision management reports to fully comprehend the work effort.
The Benefit Design Modeler allows you to Forecast the cost and utilization impact of changes in current health plan designs, and Model the likely cost and utilization pattern of new health plan designs.
• Forecast the cost and utilization impact of changes in current health plan designs, and
• Model the likely cost and utilization pattern of new health plan designs.
These models may incorporate demand-side assumptions about the shift of employee enrollment across benefit plans. To support these capabilities, users may choose from a number of forecasting / rating methodologies.
Claims analysis is a powerful resource for transforming your entire claims management lifecycle into a competitive advantage. By combining business intelligence and predictive analytics, claims analysis software helps you deliver a superior customer experience, control claims payouts and operational costs, and manage risk for a positive impact to your bottom line.
Claims analysis solutions from Skysolution help:
- • Improve customer satisfaction and retention by optimizing every customer interaction.
- • Increase operational efficiency through better use of resources.
- • Reduce fraud losses by detecting and avoiding unnecessary payments.
- • Gain deeper insights into risk exposure in order to determine optimal reserve adequacy.