Managed Insurance BPO Services for Claims, Policy and Back-Office Operations
Managed intake, document processing and validated data for recurring insurance workflows. ARDEM combines documented procedures, trained reviewers and approved automation to manage agreed processing queues, quality checks, exceptions and operating reports.
Insurance operations need more than additional processing capacity when documents arrive in different formats, required information is missing, or queues grow faster than the team can clear them. ARDEM organizes agreed processing activities around documented work instructions, quality checks, exception tracking and operating reports.
Start with a defined workflow or a connected set of administrative activities. During scoping, we review the source documents, volume, systems, required outputs, turnaround expectations and decision handoffs. Your authorized teams retain coverage, underwriting, adjudication, settlement and payment decisions.
Supporting business operations since 2004.
Review the document sources, recurring workload and output your team needs. Define the processing responsibility, quality measures and decision handoffs before moving into production.
Define a lane for document receipt, capture, validation and exception tracking within your existing claims workflow. Your authorized team retains adjudication and settlement decisions. Explore managed claims processing.
Organize application information and prepare the required fields against provider-specific instructions. Confirm formats, validation rules and review handoffs during scoping. Read the health insurance application workflow example.
Capture and validate recurring statement information into the agreed output for your reconciliation workflow. The client retains commission-rule and reconciliation decisions. Read the commission-statement processing example.
Discuss the policy records, document updates and data checks you need to delegate. Confirm the supported activities, system permissions and client approvals before including this work in the engagement. Coverage, pricing and underwriting decisions remain with authorized teams.
Agree the inputs, processing steps, client decision handoff and required outputs for your selected workflow.
For capture and validation only, explore claims data entry services.
Define who owns each processing queue, quality check, correction and escalation. ARDEM manages the agreed processing activities; client reviewers resolve information and decisions outside that scope. Keep client-pending items visible and separate from accepted completed work.
ARDEM can support workflows in client-approved systems or through an agreed ARDEM processing environment. Access, transfer methods, output formats, retention requirements and review responsibilities are defined before production. The choice depends on your existing workflow and security requirements.
Explore technology supporting managed operations and business process automation.
Start with representative documents and business rules for the selected workflow. Agree a pilot, output-acceptance checks and the point at which your team approves recurring production. Define normal and peak volumes, daily cutoffs, turnaround measurement, backup coverage, escalation contacts and the fallback when access or source information is unavailable.
Request current security documentation relevant to the proposed service and processing environment. Review authorized access, permitted data use, transfers, retention and applicable contractual requirements before sharing production records.
You have probably heard of the rising trend of outsourcing healthcare services and the increasing debate over whether it is a sustainable solution to the resource shortage in the healthcare industry. However, the bigger concerns about the fate of outsourcing healthcare services are whether these solutions are scalable or not and how can healthcare services be outsourced without compromising the quality of service?
Document capture and automation can support repeatable activities such as classification, field extraction, validation and routing. Trained reviewers handle unclear source information and items that fail agreed checks. Work requiring a business decision is escalated to the designated client reviewer. The approved tools and review requirements are established for the engagement.
The need of the hour is to equip your teams with effective collaboration tools and subscribe to a secure digital workplace that offers extensive connection, communication and sharing features. However, merely equipping your remote teams is not enough. This is the time to build a strong team, leverage diverse talent and create protocols for remote working.
Agree the documents, rules, processing steps and output acceptance before production begins.
Define the relevant field, record or document measure, review coverage, correction process and acceptance criteria.
Review processing time, accepted completed work and unresolved exceptions against agreed service measures.
Use approved automation where it fits, with trained teams accountable for quality checks, processing corrections and escalations.
Manage claims documents, data checks and exceptions within your agreed processing workflow.
Explore
Capture and validate information from healthcare and insurance claims for your processing systems.
Explore
Turn incoming documents into organized, usable information for your workflow.
ExploreShare your organization’s insurance workflow, approximate volume, current systems, required outputs and the main processing challenge. We can use that overview to discuss scope, controls and next steps.
Please do not include patient names, member or policy numbers, claim records, medical details or other sensitive information in this form. We can agree a secure channel for sample documents after the initial review.
