A smarter path to reducing claims complexity
Claims processing is more complex and costly than ever, with rising volumes and increasing regulatory demands. Carelon Global Solutions simplifies it all with a dual approach: proven claims management services combined with platform modernization strategies that streamline operations and boost efficiency across every touchpoint.
Simplified claims operations
We simplify and lower the cost of claims operations with automation, digital tools and deep payer expertise, helping to boost efficiency and prevent overpayment.
- Smart digital auditing and examining tools
- Automated high-volume reviews
- End-to-end claims administration across Commercial, Medicaid, Medicare and other government sponsored lines of business
Transparent, timely and accurate claims
We provide fast, reliable claims service by combining automation with expert support, handling complex issues with care across the entire claims process.
- High-touch claims support and fast issue resolution
- Specialized support for complex and sensitive claims types, including transplant, stop-loss, COB, and appeals
- Seamless communication and coordination across the claims ecosystem
Modernizing claims with data, audits and system upgrades
We improve claims operations using automation, analytics, and expert insights, supported by smart audits, system upgrades, and modernization capabilities that create a future-ready foundation ensuring accuracy, performance, and lasting results.
- Platform migration within health plan ecosystems for seamless adoption, vendor continuity and data migration and cleansing
- Cloud-native enablement and scalable architecture
- Predictive analytics and detection models support proactive claims management, utilization management and pricing anomaly
Claims expertise that pays off—in time and cost savings
Our team of experts employs a platform-agnostic approach that streamlines the process at every stage. When it comes to operational efficiency, the results speak for themselves.
3,500+
experienced claims
professionals
12%
annual cost savings through digital automations
20%
improvement in workflow efficiency
99.5%
financial accuracy
