Overview
Health plans are undergoing a massive shift. With demanding consumers, complex regulations, evolving competition, escalating costs and rapid technological advancements, they must act now to transform their business.
We are excited to participate in AHIP 2025, showcasing an AI-driven, integrated digital operating model designed to energize the core. Delivered as a 'Health Plan-in-a-box’, our solution unifies digital operations, applications and infrastructure into a high-performance, seamlessly integrated service factory model. It eliminates the complexities of multi-vendor ecosystems with a single accountable partner to scale and achieve better business alignment, drive synergy and reduce operational costs.
Along the front, middle and back-office functions, our model enables a cloud-connected, AI-powered strong digital core that unlocks intelligence, elevates consumer experience and translates business needs into the outcomes our health plan clients seek.
Join us at AHIP 2025, where our ideas and solutions will work together to revolutionize and build future resilient health plans.
AHIP 2025 | June 16-18, 2025 | Wynn | Las Vegas, NV
Focus Areas
Data estate modernization
Empowering health plans to harness the power of data and AI at scale with a modern, innovative and unified data estate in the cloud to operate efficiently in the new digital health economy.
Energizing the core
Modernizing and transforming health plan legacy systems to a future-proof ecosystem that enhances flexibility, agility and speed to drive innovation, foster growth and adapt swiftly to evolving market trends.
Integrated digital operating model
Solving the multi-supplier complexity through a unified digital operation, app development and infrastructure support. This simplified utility model scales productivity and drives tangible business gains through impactful outcomes.
Scale AI
Enabling health plans to reimagine their processes and experiences through GenAI-led business transformation, amplifying innovation across the value chain to enhance human effort efficiency and drive revenue growth.
Our Solutions
- Energizing the core
- Integrated digital operating model
- Data estate modernization
- Scale AI
Scale AI
Scale AI for software and product engineering
AI Force
A GenAI platform that drives service transformation across the software engineering and IT operations lifecycle. By injecting intelligence into every facet of software development – from requirements gathering, software design, coding, testing, DevOps to support and maintenance, AI Force delivers productivity gains, better quality, improved efficiencies and accelerated time-to-market.
Scale AI for operational efficiency
Payer clinical review
Leveraging multimodal GenAI, the solution automates and transforms the appeals and grievances process, enhancing clinical review efficiency. This results in reduced processing times, faster case resolutions and increased member satisfaction.
Scale AI for utilization management excellence
Smart prior authorization management
The solution automates the prior authorization process by leveraging the Agentic AI ecosystem, from intake to status tracking. This minimizes administrative burdens, simplifies compliance and accelerates care accessibility.
Scale AI for regulatory intelligence and quality compliance
CMS quality ratings
This Agentic AI solution automates administrative processes and data collection to centralize, analyze, predict and track compliance needs. It is designed to drive care performance and ensure higher quality ratings (STARS, HEDIS) by enhancing clinical outcomes and increasing engagement among members and providers.
Data estate modernization
Healthcare data aggregation, transformation and analytics
Healthcare data aggregation, transformation and analytics automates healthcare data management with cloud-enabled standards and leverages embedded data science and AI capabilities to build 360-degree personas (member and provider) and proactively identify their demand patterns.
Smart reporting
Harnessing the power of GenAI to transform health plan data analysis and reporting by automating the extraction, validation and interpretation of complex data sets. It empowers users with NLP-based intuitive chat-style data exploration and instant advanced analytics.
Provider data hub
The solution standardizes provider data models, ensures FHIR-based interoperability and enhances data accuracy. Using AI boosts member experience and engagement through 360-degree network insights.
Energizing the core
Provider lifecycle management
This solution streamlines the provider journey from onboarding to performance monitoring, using digital workflows, AI-led automation and compliant processes to reduce administrative burdens, enhance provider satisfaction and ensure regulatory adherence.
Total experience
The solution delivers personalized content and transactional functionality for consumers and health plan members. It offers an omnichannel experience through portals, apps, conversational and traditional channels, content management and AI-based personalization to enhance engagement and user experience.
Medicaid management information systems (MMIS) modernization
Transform MMIS with a scalable, modular and interoperable architecture. Our intelligent automation-driven approach simplifies administrative complexities, enhances claims processing, verifies eligibility and ensures MITA 3.0 compliance. This helps to streamline processes, reduce costs and improve the service delivery experience for Medicaid beneficiaries.
Integrated digital operating model
The digital OneOffice
A unified execution that enhances operational efficiency by streamlining digital operations, app development and infrastructure under the digital OneOffice model to drive a customer-centric experience.
Health Plan-in-a-box
Enabling a high-performance, seamlessly integrated solution and service factory model for health plans to run, grow and match the pace of business model changes and plan for the future of digital consumer personalization in the business interaction to elevate engagement.
digitalColleague
A next-generation AI-powered collaboration platform that is domain-centric and role-focused, fostering a digital workforce. It automates tasks, streamlines workflows and enables real-time decision-making to improve service quality, reduce costs and drive seamless collaboration in healthcare operations.
ASM 2.0
Powered by iONA, ASM 2.0 revolutionizes IT operations with AI-driven automation, site reliability engineering (OpsDeck), and context-aware workflows. It ensures proactive issue resolution, optimized service delivery and seamless collaboration, enhancing agility, efficiency and resilience in hybrid and cloud environments.
Our Resources
Changing face of prior authorizations
The Prior Authorizations (PA) process has been transformed by integrating AI, ML and GenAI, reducing administrative burdens, enhancing collaboration and achieving cost savings.
Next-generation core platform modernization
Healthcare CIOs are investing $22.8 billion in legacy system upgrades, focusing on core processes and moving towards value-based care, sparking digital transformation.
Analyst Recognitions
ISG
HCLTech rated as a Leader in ISG Provider Lens™ - Healthcare Digital Services, U.S. 2023
Learn moreEverest
HCLTech Positioned As A Leader And Star Performer In Everest Group’s Healthcare Provider Digital Services PEAK Matrix® Assessment 2023
Learn moreMeet Our Team
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