Healthcare Operations and Digital Transformation

Business process transformation in a connected healthcare system

Today’s healthcare ecosystem requires more than operational efficiency — it demands intelligent, connected experiences for members, providers, and care teams.

Carelon delivers operations and digital transformation solutions that help health plans operate smarter and transform faster. Powered by more than 29,000 associates, Carelon Global Solutions brings together scalable operations, intelligent automation, and modern technology enablement to improve cost, quality, and experience across the healthcare journey. Whether you need comprehensive operations management or targeted technology integration, we partner with you at every step of your transformation.

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 health 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 modernize and manage the full claims lifecycle using intelligent automation and advanced analytics to improve accuracy, ensure regulatory compliance, and accelerate processing.

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 right-shoring 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.