Healthcare Operations and Technology Services

Business process transformation in a connected healthcare system

In a connected healthcare ecosystem, business process innovation goes beyond simply increasing efficiency — it creates better experiences for your members and care providers, too.

Our operations and technology services are at the forefront of driving that change. Backed by more than 32,000 associates, Carelon Global Solutions improves health plan operations through strategic staffing and business process automation. Whether your health plan needs end-to-end operations management or precise systems integration for a singular challenge, we meet you where you are and support you throughout your transformation journey.

The precision of our healthcare expertise

98.7%

provider data accuracy

99.4%

audited claims processed accurately

97.5%

medical coding accuracy

Healthcare operations innovation well beyond implementation

Born from one of the largest healthcare insurance providers, Carelon is HITRUST certified, NCQA accredited, and wholly dedicated to healthcare. We leverage data analytics, IT systems expertise, and unrivaled health plan experience to optimize end-to-end operations.

We integrate your existing technologies with our own and with those of our market-leading platform partners to craft customized solutions that transform your business. And once our solutions are in place, our consultative approach delivers continuous innovation.

Provider Network Solutions

From enrollment and onboarding to roster and data management, we ensure your network runs efficiently, is compliant, and delivers high satisfaction for your care provider partners and your members.

Claims Management Solutions

We leverage digital solutions powered by advanced analytics to process claims with efficiency, accuracy, and in compliance with regulatory requirements.

Customer Experience Solutions

We drive customer satisfaction by balancing high-tech, high-touch engagement across inbound and outbound channels on your behalf.

Risk Adjustment and Quality Performance Solutions

To close care gaps for your members and optimize risk scores in the interest of your business, we leverage proven tools and the deep experience of coding experts.

Clinical Operations Solutions

From clinical appropriateness review to case management, our platform-agnostic operations streamline processes while our registered nurses, each with specialized training, support high-quality care for your members.

Imagining better health for your business and your members

With Carelon, you gain access to:

Tailored, scalable, end-to-end health plan operations solutions informed by best practices and refined through extensive industry experience.
Efficiencies and administrative cost advantages achieved through smart staffing and business process automation.
Continuous innovation driven by consultative leadership.
A HITRUST-certified, NCQA-accredited partner wholly dedicated to healthcare and committed to simplifying the complex in the interest of affordability and better experiences for your care providers and members.

We’re here to transform healthcare.

Interested in learning more? Let’s connect.

See healthcare from our perspective

We’re always looking ahead at healthcare trends and potential breakthrough health technologies that can transform the future of the industry and create exceptional outcomes for all stakeholders.