Healthcare is complicated. And delicate. It takes a skilled and empathetic person to address healthcare inquiries because they hit on two of the most sensitive aspects of our lives: our health and our finances. Healthcare has its own language and terminology that can be challenging to understand and navigate. Our experts have the right touch to connect and empathize with the person on the phone.
Our leadership team is unique in the BPO space–we have centuries worth of combined payer operations experience. This coupled with our industry-trained agents consistently produces superior member experience outcomes.
Health Plans
Helpware supports healthcare payers in every major health plan category.
Individual + Family Plans
Your customers need experienced and empathetic help navigating the complexities of their health plans and benefits. Our seasoned teams have the expertise to walk them through their best options.
Our unique work-from-home model means you can get the specialized agents you need to efficiently handle seasonal ebbs and flows of call volume.
Medicare
Every year, private insurers offering Medicare Advantage (MA) plans deal with the chaos of the Annual Enrollment Period (AEP). This is the critical window of time when efforts spike. More recently, the growth of private exchanges in the Medicare retiree segment has intensified the competition for customers.
Helpware has a long history of helping 4 and 5-star plans, tackle the challenges faced by MA, MAPD, and PD plans during AEP. We provide licensed telesales, sales support/triage, post-enrollment support, and provider enrollment.
Acquiring Medicare customers is becoming the top priority for health plans. Our ability to recruit and staff the right number of experienced and effective licensed agents allows your plan to ensure each call is taken and no opportunities are missed.
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Commercial
Commercial clients work hard to create plans that meet both the needs of their employees and the pressures of the bottom line. This results in a range of plans that are as varied as the organizations themselves.
No matter what the size of the organization, or the nature of the plan, Helpware can help commercial clients administer their health insurance programs. Our extensive healthcare experience enables us to bring the right people and systems to each engagement, reducing the burden on these organizations so they can focus on running their businesses.
Services
Turn to Helpware for help with the people-first, quality services your members demand.
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Member Service
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Provider Service
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Claims
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Clinical
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Sales
Member Service
Your members want their interactions with health plans to be as efficient and “easy” as possible. Delivering on their expectations requires having the right number of people with the right experience and training, who actually enjoy their jobs. That’s why so many health plans turn to Helpware for cost-effective solutions for delivering ideal member experience outcomes.
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Provider Service
Working with providers on claim status can fall into different priority levels for different plans. Helpware ensures you have the right solution to address those priorities, whether it’s an offshore solution for efficiency gains or domestic solutions for select provider partners.
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Claims
The complexity of claims processing makes it a natural fit for Helpware’s transformational business model. Our tenured workforce has experience with all of the leading claims systems and can expertly manage specialized and complex claim processes. Whether your claims processing needs are episodic or ongoing, simple or multidimensional, we can handle them with the right onshore or offshore solutions.
Claims Processing services include:- Full adjudication
- Adjustments
- Recoveries & COB
- Medical Review
- Appeals & Grievances
- Audit & QA
- Pricing
- DST® (AMISYS™, POWERMHS™)
- FACETS™
- DELL® (DIAMOND™, XCELYS™)
- HEALTHEDGE® (HEALTHRULES™)
- HP®/ EDS® (METAVANCE™)
- OTHER PROPRIETARY
- NASCO
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Clinical
Helpware’s healthcare services include handling clinical calls that relate to overall health and wellness. Leading health plans count on our highly-trained remote workforce to deliver superior outcomes across a range of services including: Health Risk Assessments, Case management, Utilization management, Disease management, Pharmacy.
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Sales
Handling sales in the healthcare environment is a uniquely complex challenge. In addition to being able to explain complex products, telesales agents need specific certifications and skills which vary by plan type and state. And it’s nearly impossible for plans to accurately predict call demand, which makes staffing levels a challenge.
Health plans tackle these challenges by partnering with Helpware for telesales. Our flexible, scalable approach enables plans to get the right level of experience agent support when they need it. Our clients find our industry-leading attrition rates are critical during this limited seasonal window where backfill is not possible.