Appeals and grievances (A&G) is a complex highly regulated back-office function in a health plan involving significant emotional connect with the member and the provider. Today’s A&G function deals with several challenges – complex medical necessity determination, correspondence and penalty management to ensure satisfaction. Leveraging digital techniques, A&G function can be transformed to achieve higher satisfaction for both member and provider.
Appeals and grievances (A&G) is one of the most critical consumer-facing functions, of health plans, which has not only process overheads but also sensitivity involved with regard to service experience and loyalty. Health plans deal with several challenges in this function today – manual intensive processes around correspondence generation and management, complex clinical reviews and cumbersome decision-making process. As the systems are diverse, information generation is a lengthy process that further impacts SLA, productivity and efficiency of the service.
The webinar will provide an approach to transform A&G function deriving upon the AI & digital technologies to address their objectives of minimum disruption, process efficiency and customer satisfaction
Associate Vice President, Client Partner & Head of Products, Platforms and Solutions
Vadi is an IT Executive with 21+ years of IT experience and 14+ years of healthcare payer consulting experience focusing implementation and system integration of core administration platforms. In his current role as Head of Products, Platforms & Solutions, he is focusing on developing products and solutions leveraging digital, AI and RPA to improve payer operations as well as optimizing medical costs through AI augmented care management.