Elevating the Healthcare Professional Experience
The healthcare industry is undergoing a fundamental shift. Member-centric, outcome-based care is now the priority — all while payers adapt to new regulatory and financial frameworks. This transformation requires robust IT systems that enable digital transformation to be realized.
As payers move toward richer digital experiences, seamless data interoperability and deeper stakeholder engagement, new opportunities emerge. By collaborating more closely, sharing patient data proactively and creating engaging member experiences, payers can capture mindshare and boost retention.
We're working with leading health plans to blend innovative digital solutions and data-driven insights with forward-thinking collaboration. Together, we're achieving the quadruple aim — reducing care costs, improving outcomes, enhancing member satisfaction and elevating the healthcare professional experience.
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Success Stories from Our Work with Healthcare Payers
Navigating healthcare operations with data-enabled transformative insights
Unveiling Informatica’s dominance: Inside the operations of America’s largest managed healthcare consortium
Improving cybersecurity posture with HCLTech cybersecurity consulting
HCLTech cybersecurity consulting fortified a leading health conglomerate's cybersecurity with a tailored solution, ensuring robust defense and operational continuity
Revolutionizing health plans’ clinical review process with GenAI
HCLTech's GenAI-powered platform transformed a regional Blue Plan's clinical review process, achieving 85% faster reviews and boosting satisfaction for members and providers.
Scaling data with Azure, Databricks, Snowflake and AI for a leading health plan
Discover how HCLTech helped a major US health plan migrate data to the cloud using GenAI, automation, and advanced architecture, boosting performance, user adoption and decision-making.
Boosting a regional health plan's digital agility with unified experience portal
Enhancing member engagement and efficiency with personalized, scalable and unified digital experiences
Integrated delivery model helps major health plan thrive in new market dynamics
HCLTech's integrated delivery model revitalized a regional health plan, driving synergy, transformation and efficiency gains while reducing costs and enhancing service delivery.
Awards and Recognitions
HCLTech recognized as a Leader in Everest Group’s Healthcare Data, Analytics and AI Services PEAK Matrix® Assessment 2025
Learn moreHCLTech rated as a Leader in ISG Provider Lens™ - Healthcare Digital Services, U.S. 2023
Learn moreHCLTech rated as a Leader in ISG Provider Lens™ - Payer Digital Transformation Services, U.S. 2023
Learn moreHCL Technologies rated as a Star Performer & Leader in Everest Group Healthcare Payer Digital Services Peak Matrix® Assessment 2022
Learn moreTrends and Insights
Total Experience: The future of healthcare payer engagement
Total Experience solution unifies health plan touchpoints with real-time personalization, tech modernization and connected journeys, boosting satisfaction, efficiency and innovation.
Healthcare data aggregation, transformation and analytics
HCLTech's healthcare data solution unifies and transforms health plan data, using AI for insights and compliance, boosting decision-making, cutting costs and enabling digital transformation.
Smart reporting
Smart reporting solution enhances efficiency for health plans by using analytics to cut manual effort, unify data and deliver real-time insights, boosting decision-making and cost optimization.
Provider data hub
HCLTech's provider data hub uses AI to centralize and validate provider data, ensuring accuracy, compliance and seamless interoperability, enhancing care coordination and digital transformation.
Smart prior authorization
Smart prior authorization leverages Agentic AI to streamline prior authorization processes, reducing turnaround time to under 2 days, enhancing accuracy, compliance and stakeholder experience.
CMS Star Ratings assist
HCLTech’s Star rating assist uses GenAI to help Medicare Advantage plans boost CMS ratings, recover lost revenue and improve engagement with real-time data, predictive insights and automation.
Revolutionize member enrollment with a next-gen platform
Boost customer experience and loyalty
'Super Agents' for elevated customer experience
In today's digital era, inefficient contact center agent systems and platforms have emerged as the primary obstacle to driving customer engagement.
Medicaid management information systems (MMIS) Modernization
MMIS Modernization enables states to adopt modular, cloud-native systems aligned with CMS/MITA 3.0, ensuring seamless integration, better data exchange and long-term operational gains.
Payer clinical review
Payer clinical review uses GenAI, semantic search and summarization to boost accuracy, ensure compliance and allows people to focus on high-value tasks.
Health Plan-in-a-box
Health Plan-in-a-box simplifies legacy systems with a cloud-native, AI-powered solution that boosts agility, scalability and compliance for future-ready health plans
Provider Lifecycle Management
Provider lifecycle management solution transforms provider lifecycle with AI, automation and cloud to cut costs, boost accuracy and enhance engagement, driving digital healthcare transformation.
What is artificial intelligence (AI) in healthcare?
The application of AI in healthcare has resulted in a number of tangible benefits, including early disease detection, faster and more accurate analysis of medical images, robotic surgery, accelerated drug discovery, and more.
How Total Experience can transform healthcare businesses
The cure for the healthcare distrust epidemic is collaboration. Total Experience connects stakeholders, improves care and rebuilds trust
The impact of Generative AI in healthcare: Revolutionizing patient care
The advent of generative AI is leading to the transformation of healthcare and, especially, the hyper-personalization of patient care
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.
Meet Our Ecosystem Partners
Frequently Asked Questions about Healthcare Payers Solutions
Health plans today face rising healthcare costs, regulatory changes, legacy IT systems and growing member expectations for digital-first experiences. We see clients struggling with fragmented data, compliance pressures and the need for seamless interoperability. These challenges require innovative, scalable healthcare payer solutions that balance cost, quality and member satisfaction.
Digital transformation enables payers to modernize operations, improve member engagement and respond quickly to regulatory shifts. From our experience, adopting digital healthcare payer solutions software enhances efficiency, supports real-time data exchange and creates personalized experiences—key for staying competitive and achieving better outcomes in today’s evolving healthcare landscape.
Modern payer platforms streamline enrollment, claims and communication, enabling seamless digital interactions and personalized support. We design healthcare payer solutions that unify data, automate processes and connect stakeholders, resulting in faster service, greater transparency and a more engaging member journey—ultimately boosting retention and satisfaction.
Absolutely. Our healthcare payer solutions are designed to support commercial, Medicare and Medicaid (MMIS) markets. We tailor digital adoption and modernization strategies to each program’s unique requirements, helping clients streamline operations, ensure compliance and deliver high-quality, accessible care to diverse member populations.
We prioritize cloud security by employing industry-leading protocols, continuous monitoring and proactive threat detection. Our healthcare payer technology solutions leverage encryption, identity management and compliance frameworks to safeguard sensitive health data, ensuring our clients’ information remains protected, private and compliant with all relevant regulations.
We help payers reduce costs by leveraging advanced healthcare payer technology solutions, including AI-driven automation, data analytics and cloud-first architectures. Our experience shows that optimizing administrative workflows, enhancing clinical decision-making and improving data integration can drive sustainable cost savings without compromising care quality or compliance.
Analytics are at the heart of informed decision-making for payers. Our healthcare payer analytics solutions help clients gain actionable insights from claims, clinical and operational data, enabling smarter risk management, fraud detection and care optimization. With robust analytics, payers can enhance outcomes, control costs and improve member satisfaction.
We support regulatory compliance by implementing secure, scalable solutions that align with evolving healthcare standards. Our expertise in healthcare payer services & solutions includes AI-powered auditing, automated claims analysis and real-time monitoring, helping clients identify potential issues early and maintain compliance across HIPAA, CMS and other critical regulations.
Technologies such as API-driven platforms, FHIR standards, cloud integration and advanced data hubs are key to improving interoperability. We use these tools to connect disparate systems, enable real-time data exchange and facilitate collaboration among payers, providers and partners, resulting in more coordinated, value-based care.
Our ecosystem partners extend the value of our healthcare payer services & solutions by providing specialized technologies, deep industry expertise and innovative platforms. Together, we deliver integrated, future-ready solutions that accelerate transformation, enhance interoperability and help clients achieve better outcomes across the healthcare value chain.
