Healthcare BPO services for payers, providers & health plans
At Infosys BPM, we combine our strong domain expertise, flexible operating model, and integrated IT-BPM solutions to address the changing dynamics of the healthcare industry through our healthcare BPO capabilities. Our healthcare BPO services are designed to transform operating models, improve business performance, and standardize processes with reduced costs for healthcare providers and organizations.
Why leading health plans choose our healthcare BPO services
We deliver comprehensive, end to end BPO services for the healthcare sector, encompassing benefits administration, member management, claims administration, provider data management, analytics, appeals processing, and clinical services. Our scale, geographic reach and operational depth enable us to support complex healthcare ecosystems with accuracy and efficiency.
HIPAA-compliant healthcare business process outsourcing
Our healthcare business process outsourcing model is designed around the regulatory realities of US healthcare, so compliance is embedded into every SLA, not managed as a separate workstream. From HIPAA data privacy obligations to CMS reporting requirements and state-specific appeal regulations, Infosys BPM's BPO services for healthcare keep your operations audit-ready across every function we manage.
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Built for the compliance demands of US healthcare operations
Healthcare data carries the highest regulatory obligations of any industry, and your BPO partner's compliance posture directly affects your risk exposure. Infosys BPM's healthcare business process outsourcing model is structured around HIPAA, HITECH, and state-specific privacy requirements across every function we manage.
| Framework | How we support it |
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HIPAA Privacy & Security Rules |
Role-based access controls, data segregation, and audit-ready documentation across all member, provider, and claims data handling |
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HITECH Act |
Enhanced breach notification protocols and electronic health record handling procedures embedded into every engagement SLA |
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CMS Regulations |
Medicare Advantage and Medicaid compliance support, covering enrolment, claims, and reporting obligations across all CMS-regulated lines |
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State Privacy Requirements |
Jurisdiction-specific compliance monitoring across all 50 states where we manage appeal transactions and member services |
Key stats of our healthcare business process outsourcing
30M+ health plan memberships across 19 states
26M+ claims processed annually
200K+ group benefits coded annually (including plan setup)
150K providers serviced through provider data management
~8.4M+ clinical services volumes processed annually
~1.5M+ appeal transactions handled annually across 50 states
End-to-end healthcare BPO services offerings
Claims administration
- Claims data entry
- Claims adjudication
- Claims adjustments
- Claims audit
- Overpayment recovery
- Cross accumulation
Benefit administration
- Plan setup/case install
- Benefit coding
- Benefit testing
- Contract drafting
- Legislative review
Member management
- New membership
- Enrollment and eligibility
- Premium billing and reconciliation
- Member grievance and appeals
Provider management
- Provider credentialing
- Provider data management
- Provider contract management
- Provider grievances and appeals
- Provider network onboarding
Clinical services
- Medical necessity reviews
- Prior authorizations
- Member satisfaction surveys
- Utilization and case management
- Pharmacy intake
- HEDIS reporting
Customer experience
- Member and provider support
- Member onboarding
- Eligibility and enrollment
- Health plan digital marketing
- Clinical calls
- Service desk support
Standardise processes to reduce costs
Healthcare BPO services for payers, payer solutions & administration
Infosys BPM's healthcare payer solutions are built for health plans managing complex administrative ecosystems at scale, from commercial and Medicare Advantage to Medicaid. With 26M+ claims processed annually and 30M+ health plan memberships supported across 19 states, our payer services deliver the accuracy, compliance, and operational depth that health plans need to reduce administrative costs while improving member outcomes.
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Healthcare payer solutions for claims & member management
Our claims administration and member management services cover the full lifecycle, from enrolment and eligibility verification through claims adjudication, dispute resolution, and appeals processing. With 1.5M+ appeal transactions handled annually across 50 states, our payer services healthcare model is built for scale, accuracy, and regulatory compliance at every stage. -
Benefit administration & open enrolment services
From plan setup and group benefits coding (200K+ annually) to open enrolment automation and member communications, our benefit administration services cover the full annual cycle, AI-powered workflow management reduces manual effort and improves accuracy across every enrollment touchpoint, so your teams can focus on member experience rather than administrative execution.
Healthcare BPO insights
Success stories
Bringing values to businesses through our products and services
Our healthcare BPO services offerings
Discover solutions, services and offerings for healthcare
BPM specific offerings
- Claims management
- Provider / network management
- Member management
- Plan / benefit management
- Care management
- Medical management
- Business analytics
Point solutions
- Claims OEMS
- Assist Edge
- Benefit testing
- Infosys iTransform
- HWAK Eye
- iBeat
- iEDPA (Data privacy suite)
- TeSteward
- AcceleraTest
Healthcare BPO – challenges and solutions
Healthcare organizations are drowning in administrative complexity, and outsourcing is one of the few levers that addresses both cost and operational quality at the same time, with revenue cycle management and claims management consistently identified as the highest-ROI functions to outsource. For payers, the strongest ROI comes from claims administration, member management, and appeals processing, where specialist expertise and AI-powered automation reduce cost-per-claim and denial rates simultaneously. For providers, revenue cycle management and provider data services deliver the fastest measurable returns.
Compliance in a healthcare business process outsourcing engagement is embedded into the delivery model, not managed as a client-side responsibility. A structured BPO partner operates with HIPAA-compliant data handling protocols, role-based access controls, audit-ready documentation, and dedicated regulatory monitoring across CMS, state privacy laws, and appeal processing requirements, ensuring your health plan remains compliant without expanding your internal compliance function.
Your member contact center is more than a support channel, it is a frontline determinant of your STAR ratings, and every interaction influences how members perceive your plan. A Global Delivery Model spanning multiple time zones provides on-demand capacity that scales with open enrollment volumes, claims surges, and catastrophe event peaks, without carrying year-round headcount sized for worst-case scenarios, and without any degradation in SLA performance during the periods that matter most. Magistral
Organizations focusing on superior member experience achieve 1.6 times higher member retention than those that don't, making member experience a measurable financial lever, not just a service quality metric. AI-powered healthcare BPO services improve member satisfaction by reducing claims resolution times, improving first-call resolution rates, and delivering consistent, accurate responses across member management and appeals processing, all while reducing the cost-per-interaction for the health plan. Magistral
The adoption of digital health solutions and value-based care models is expected to further propel the growth of provider services, with revenue cycle management expected to dominate the provider services segment. A specialist health BPO partner supports the value-based care transition by providing population health analytics, care management operations, clinical documentation support, and provider data accuracy, enabling health systems and payers to measure and report on outcomes-based metrics without building the supporting operational infrastructure in-house.
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