Member Experience / Appeals and Grievances Management

Intelligent Appeals and Grievances management solution

Automate and optimize your appeals and grievance (A&G) management with AI-driven solutions to enhance efficiency, ensure compliance, and boost member satisfaction.

Value & Benefits

Improved processes, measurable outcomes

Beyond compliance and efficiency, our A&G platform profoundly impacts member experience. It seamlessly integrates with your existing IT infrastructure to ensure robust data security and scalability, empowering your organization to grow and adapt continuously.

Value
Benefits

Elevate your appeals and grievances process by automating case management, reducing resolution times, and ensuring compliance.

Realized operational improvement

0 %

Reduction of resolution times on grievances

0 %

Reduction of resolution times on appeals

0 %

In time saving of Compliance reporting and Universe generation

0 %

Experience the benefits of faster case resolution, improved accuracy, and higher member satisfaction. With AI-powered automation, your organization can focus on delivering exceptional service while maintaining full compliance with regulatory standards.

Accelerated case
resolution

Speed up the appeals and grievances process with automation, reducing resolution times and enhancing member satisfaction.

Enhanced and
continuous compliance

Maintain strict adherence to applicable regulatory standards with built-in compliance features, minimizing the risk of penalties.

Improved decision
accuracy

Leverage AI-driven data-backed insights to make more informed and accurate decisions, ensuring fair and consistent outcomes.

Increased operational
efficiency

Free up staff from manual tasks through automation, allowing them to focus on more complex and strategic initiatives.

Key features

Optimize your A&G operations

Inovaare automates appeals and grievances processes, empowering A&G professionals to operate efficiently, with reduced reliance on IT support.

A&G management

Effortlessly manage appeals and grievances! Automate workflows, reduce manual effort, and ensure timely resolutions. Improve compliance and operational efficiency while enhancing member satisfaction with seamless, accurate, and real-time tracking of appeals and grievances. ×

Member journey dashboard

Gain Comprehensive Insights into Member Journeys! Track every touchpoint and interaction across the member lifecycle, providing a holistic view that drives better decision-making. Identify trends, improve service delivery, and increase member satisfaction with detailed, actionable insights. ×

PQI & QIO

Ensure the highest standards of quality care with our Potential Quality Issue (PQI) & Quality Information Organization (QIO) solutions. Automate quality improvement processes, monitor performance metrics, and comply with regulatory standards. Drive continuous improvement in care delivery and outcomes, and maintain excellence in healthcare services. ×

Data scrubber suite

Our Data Scrubber Suite helps you maintain clean, accurate data for all your reporting needs. Automate data scrubbing processes to identify and correct errors, ensuring compliance with regulatory requirements. Improve data integrity, reduce risks, and enhance decision-making with reliable data. ×

Workflow Automation

Effortlessly manage appeals and grievances

With a flexible A&G platform, you can configure and automate workflows, reduce manual effort, and ensure timely resolutions to improve and optimize your A&G management processes. You can also seamlessly, accurately, and in real-time track appeals and grievances.

Continuous compliance

Compliance on point, always

Effortlessly generate accurate, compliance-ready reports, keeping your organization aligned with ever-changing regulations, reducing the risk of penalties, and ensuring consistent regulatory adherence.

Low total cost of ownership

Maximize ROI with an intelligent platform

Achieve a high return on investment with our cost-effective, self-service platform. Enjoy tangible benefits like automated processing allowing you to do more with fewer people.

Data scrubber

Ensure data accuracy and integrity

Build custom rules to automate data scrubbing processes to identify and correct errors and outliers, ensuring compliance with regulatory requirements, data integrity, lower risks, and better decision-making with reliable data.

Automated case management

Smart case management with AI precision

With our AI-powered case management, streamline and automate case intake and categorization. Enjoy reduced processing times, enhanced accuracy, and improved compliance, all while boosting member satisfaction and making your A&G operations more streamlined, effective, and responsive.

Professional services

Leverage specialized services

Access specialized A&G staff for process management, staff augmentation, and operational assessment, ensuring expert oversight and improved operational efficiency.

Usher AI