Solutions / Markets Served

solutionS / Healthcare functions

Appeals & Grievances

Facing challenges in managing appeals and grievances efficiently? Automate case management and drive regulatory compliance for quick resolutions that enhance member experience and operational effectiveness. 

Value to your organization

• Strong compliance posture
• Faster resolutions
• Cost reductions

Benefits we bring

• Automated case management
• Faster resolution times
• Enhanced member satisfaction

Heathplan functions / Compliance and Audit

Automate compliance and streamline audits

Automate critical tasks such as tracking, reporting, and data validation, ensuring your organization stays compliant with minimal effort. With real-time dashboards and audit trails, your team can focus on strategic initiatives while reducing the risk of penalties and audit failures. 

Value to your organization

• Automate compliance tracking
• Streamline audit processes
• Reduce audit costs and effort

Benefits we bring

• Automated compliance tracking
• Reduced manual audit effort
• Improved audit readiness
• Minimized compliance risks

Heathplan functions / Delegation oversight

Centralize oversight for compliance and performance

Centralize your delegation oversight process with tools like the Delegate Repository, automated evaluations, and built-in compliance monitoring. By streamlining oversight, your organization can ensure all delegates meet regulatory requirements while improving overall performance and accountability.

Value to your organization

• Centralize delegate information
• Streamline delegate evaluations
• Enhance audit readiness

Benefits we bring

• Centralized delegate management
• Automated performance evaluations
• Real-time compliance monitoring
• Efficient corrective action tracking

Heathplan functions / IT

Enhance IT efficiency with scalable, secure solutions

Empower your IT department with scalable, secure, and compliant infrastructure. With HIPAA-compliant security protocols and automated compliance monitoring, your IT function can focus on innovation while ensuring regulatory adherence and operational efficiency.

Value to your organization

• Enhance security and compliance
• System reliability and scalability
• Streamline system integration

Benefits we bring

• Seamless system integration
• Scalable cloud infrastructure
• Enhanced security protocols
• Faster app development

helathplan functions / Member services

Boost member satisfaction with faster, personalized service

Deliver a superior member experience by streamlining and automating member communication and issue resolution, ensuring faster response times and personalized service. With real-time reporting and dashboards, your Member Services team can reduce resolution times and improve member satisfaction, building long-term loyalty and trust.

Value to your organization

• Improve reporting and insights
• System reliability and scalability
• Proactive member support

Benefits we bring

• Faster issue resolution
• Personalized communication
• Real-time performance monitoring
• Increased member retention

helathplan functions / Sales and marketing

Boost member satisfaction with faster, personalized service

Drive member growth and retention with insights-driven solutions that empower health plans to personalize engagement and enhance outreach effectiveness. Our tools help your team make data-backed decisions, optimize campaigns, and measure impact in real time—turning every interaction into a strategic advantage.

Value to your organization

• Equip teams with actionable insights to drive smarter, more targeted campaigns.
• Enhance member experience through personalized interactions.
• Measure campaign performance in real time to optimize outreach strategies on the go.

Benefits we bring

• Increased member retention
• Optimized campaign effectiveness
• Improved sales outcomes

helathplan functions / Quality improvement

Boost member satisfaction with faster, personalized service

Elevate care standards and outcomes with robust quality improvement solutions designed to meet regulatory demands and optimize care delivery. From tracking key performance metrics to implementing corrective actions, our solutions help you ensure compliance while fostering a culture of continuous improvement and excellence in patient care.

Value to your organization

• Stay ahead of evolving regulations with built-in compliance checks.
• Monitor quality metrics consistently to maintain high standards of care.
• Identify and address quality gaps swiftly with automated workflows for corrective action.

Benefits we bring

• Enhanced patient outcomes
• Reduced compliance risks
• Operational efficiency and productivity

Heathplan functions / Provider Relations

Strengthen provider relationships with efficient communication

Managing provider relationships is key to delivering quality care. By simplifying provider interactions, your organization can improve collaboration, reduce administrative burdens, and develop strong, transparent, and long-term partnerships.

Value to your organization

• Streamline provider communication
• Monitor provider performance
• Optimize network performance

Benefits we bring

• Improved provider communication
• Efficient contract management
• Performance monitoring
• Stronger provider relationships

Markets Served / Medicare Advantage Healthplans

Solve compliance and cost challenges efficiently

Worried about balancing the opposing objectives of meeting Medicare compliance standards and controlling costs? Our solutions streamline compliance monitoring and automate operational processes to ensure adherence to regulations and reduce operational expenses.

Value to your organization

• Never worry about compliance
• Cut costs effortlessly
• Boost member loyalty

Benefits we bring

• Automated compliance monitoring
• Reduced operational costs
• Enhanced member satisfaction
• Improved audit readiness

Markets Served / Medicaid Healthplans

Streamline medicaid compliance and efficiency

Facing the complex challenges of Medicaid compliance and operational efficiency? Our comprehensive solutions are designed to tackle the unique hurdles of Medicaid markets, ensuring seamless adherence to regulations, cost control, and enhanced member engagement.

Value to your organization

• Never miss a compliance deadline
• Streamline operational costs
• Enhance member experience

Benefits we bring

• Simplified compliance management
• Cost control through process automation
• Enhanced member communication
• Improved performance monitoring

Markets Served / Commercial Healthplans

Don’t just survive; dominate the commercial market

Our innovative solutions are designed to streamline your operations, ensure compliance, and enhance member interactions, helping you lead the market with confidence.

Value to your organization

• Automated compliance monitoring
• Enhance financial performance
• Personalize member experiences

Benefits we bring

• Financial performance optimization
• Automated regulatory compliance
• Personalized member communication
• Faster claims and grievance resolution

Markets Served / ACA Healthplans

Maximize efficiency and compliance for dual-eligible plans

Struggling to meet the unique needs of dual-eligible members while ensuring compliance? Our targeted solutions streamline operations, ensure adherence to regulations, and improve member care coordination.

Value to your organization

• Enhance care coordination
• Stay ahead of compliance
• Boost member engagement

Benefits we bring

• Streamlined care coordination
• Automated compliance monitoring
• Personalized member engagement
• Optimized network management

Markets Served / ACOs and IDNs

Custom solutions for specialty health plans

Navigating the complexities of specialty health plans requires precision and specialized tools. Our comprehensive solutions streamline operations, ensure compliance, and enhance member care to help you thrive in this specialized market.

Value to your organization

• Improve care coordination
• Ensure regulatory compliance
• Boost member satisfaction

Benefits we bring

• Improved care coordination
• Real-time compliance monitoring
• Boost member satisfaction
• Data-driven decision-making

Markets Served / Healthcare Providers

Empower your medical group to excel

Streamline operations, enhance patient engagement, and ensure compliance in your medical group with our comprehensive technology solutions. Our tools are designed to meet the unique needs of medical groups, driving efficiency and improving patient care.

Value to your organization

• Reduce clinical costs
• Stay compliant effortlessly
• Boost patient engagement

Benefits we bring

• Improved practice efficiency
• Effortless compliance
• Boost patient engagement
• Reduce clinical costs

Markets Served / PHARMACY BENEFIT MANAGEMENT (PBM)

Optimize drug utilization and cost management

Need to improve drug utilization and manage costs effectively? Our PBM solutions provide integrated data analytics and automated compliance monitoring, empowering you to streamline operations and enhance service efficiency.

Value to your organization

• Reduced drug costs
• Ensure regulatory compliance
• Enhance service efficiency

Benefits we bring

• Reduced drug costs
• Effortless regulatory compliance
• Improved claims processing
• Enhanced provider relations

USE CASE / Member Service Operations

Faster service and resolutions, happier members

Reduce response times and resolve issues with ease. Automated member service operations free up your team and keep members satisfied.

• Seamless Interaction
• Personalized Communication
• Automated Workflows
• Real-Time Analytics

USE CASE / Healthcare GRC Management

Simplify risk management and optimize operations

Worried about compliance risks? Our governance, risk, and management solutions help ensure your organization meets all regulatory requirements wile operating at optimal levels.

• Compliance Monitoring Tools
• Automated Reporting
• Policy Management
• KPI Monitoring

USE CASE / Provider Data Management

Clean data, informed decisions

Keep your provider data clean, accurate, and up-to-date with automated data scrubbing and management. Trust your data to make informed decisions.

• Automated Workflows
• CMS Compliance
• Performance Monitoring

Use Case / Delegation/Vendor Oversight Management

Create a culture of compliance with real-time oversight

Simplify delegation oversight with automated tools that track performance, compliance, and deliver accurate data every time.

• Performance Monitoring
• Audit and Review
• Real-Time Reporting
• Automated Alerts

Use Case / CMS Audit Universe Management

From data chaos to clarity

Let automation handle your universe management—from generation to submission—delivering clean, CMS-compliant data fast, every time.

• User Concurrency
• Error-Free Submission
• Real-Time Reporting
• Custom Rules

BI & Data Analytics / Member Satisfaction

Measure and improve member satisfaction with data insights

Struggling to keep your members satisfied? Use analytics to understand member feedback and behavior, creating tailored experiences that boost satisfaction and loyalty.

• Customized Dashboards
• Personalized Outreach
• Service Performance Metrics
• Proactive Trend Monitoring

BI & Data Analytics / Compliance Risk

Monitor and manage compliance risks timely and effectively

Analyze and manage compliance risks before they become issues. Track potential threats and ensure your organization remains within regulatory lines.

• Real-Time Monitoring
• Automated Risk Reports
• Audit-Ready Documentation
• Customizable Compliance Rules

BI & Data Analytics / Delegation Performance

Track and improve delegation performance seamlessly

Understand and improve the performance of your delegated entities with powerful analytics. Track outcomes, performance, and compliance metrics seamlessly.

• Performance Dashboards
• KPI Tracking
• Comparative Analytics
• Data Insights

BI & Data Analytics / Regulatory Impact

Have a deep view of how regulations impact your operations

Assess how new regulations will affect your operations with forward-thinking analytics. Plan and adapt to changes before they become challenges.

• Data-Driven Decisions
• Custom Reporting
• Risk Mitigation Strategies
• Cross-Function Collaboration

Healthcare Experts and Technology Outsourcing / Appeals & Grievances

Handle appeals and grievances with expert precision and process interventions

Rely on our industry experts and cutting-edge technology to streamline the handling of appeals and grievances. Improve member satisfaction by ensuring swift, accurate, and compliant resolutions.

• Automated Workflow
• Compliance Assurance
• Customizable Letters
• Real-Time Analytics

Healthcare Experts and Technology Outsourcing / Provider Disputes

Resolve provider disputes quickly and efficiently

Trust our proven expertise and advanced tools to manage provider disputes with ease. We ensure quick, transparent resolutions that maintain strong provider relationships and keep your operations running smoothly.

• Fast-Track Resolution
• Transparent Communication
• Centralized Case Management
• Data-Driven Insights

Healthcare Experts and Technology Outsourcing / regulatory audits

Navigate regulatory audits with confidence and ease

Utilize our expert knowledge and technology to ace regulatory audits. We streamline your audit processes, ensuring compliance with CMS and state regulations while reducing operational costs.

• Audit Preparation
• Compliance Monitoring
• Data Management
• Compliance Advisory

Experience:

Location:

Job Type:

Qualifications:

• Bachelor’s or Masters’s degree in Computer Science, Engineering, or a related field.
• Advanced degrees preferred.

Job Requirements:

• Minimum 15 years of experience in software development and architecture.
• Proven experience with multiple technology stacks (e.g., Java, .NET, Python, etc.).
• Experience in low-code no-code platforms like Salesforce, Appian, Pega, OutSystems, Quickbase etc.
• Strong understanding of cloud computing, microservices, and API-driven architecture.
• Experience with database design and management.
• Familiarity with Agile methodologies and DevOps practices.
• Excellent problem-solving and analytical skills.
• Strong communication and leadership abilities.

Job Responsibilities:

• Design and Develop Scalable Platform Architectures
• Evaluate and Incorporate New Technologies
• Lead Cross-Functional Teams
• Ensure Platform Reliability, Security, and Efficiency
• Collaborate with Stakeholders

Preferred Skills:

• Experience in a healthcare technology environment.
• Knowledge of regulatory compliance standards relevant to the healthcare industry.
• Experience with AI and machine learning technologies.
• We encourage you to apply if you meet the above requirements and see yourself as a good fit for the role. Please submit your resume and portfolio to ruth.chhetry@inovaare.com with “Resume for Platform Architect” in the subject line.

Product Suite / Provider network operations

Provider Dispute Management

Efficiently manage and resolve provider disputes to ensure timely resolutions, reduce administrative burdens, and foster transparent and collaborative relationships.

Product Suite / Risk management

Compliance Risk

Automate compliance tracking, monitor changes in real-time, and get instant alerts to prevent violations before they occur. Keep your team focused on what matters—delivering quality care—while we take care of compliance.

Product Suite / Risk management

Operational Risk

Identify systemic inefficiencies, manage potential disruptions, and streamline workflows across your organization. Gain real-time insights into your operational landscape and take swift action to mitigate risks that could impact your performance or profitability.

Product Suite / Risk management

Third party Risk

Gain complete visibility into your vendor and partner relationships, ensuring they meet regulatory requirements and maintain high standards. Monitor performance, compliance, and risks in real-time to protect your organization from third-party vulnerabilities.

Product Suite / Regulatory Compliance Management

Regulatory Library

Access up-to-date regulatory information to ensure your organization remains compliant with the latest healthcare regulations. Leverage a centralized, efficient platform to manage and stay updated with the latest healthcare regulations so that you’re always compliant, mitigating risks and enhancing operational efficiency.

Product Suite / Regulatory Compliance Management

Contracts Management

Manage and monitor all your contracts efficiently through a centralized platform to automate compliance checks and ensure timely renewals to mitigate risks and enhance vendor relationships. Centralize and simplify contract management through a single platform for all contract-related activities to ensure compliance, enhance efficiency, and reduce risks.

Product Suite / Regulatory Compliance Management

Policies & Procedures

Say goodbye to the manual grind and hello to a smarter, swifter way to manage your policies and procedures. Automate updates, ensure consistency and watch your compliance game soar.

Product Suite / Regulatory Compliance Management

Issue Management

Identify, track, and resolve compliance incidents proactively to automate issue logging, prioritize resolutions, and monitor progress to maintain a compliant and efficient operation. Automate your incident tracking, prioritize resolutions, and watch as your compliance performance skyrockets.

Product Suite / Regulatory Compliance Management

Corrective Action Plan

Manage and implement corrective actions seamlessly. Automate the creation, tracking, and resolution of corrective actions to address compliance issues promptly and effectively. Don’t let compliance issues drag you down. Automate your corrective actions, track progress effortlessly, and watch your compliance posture improve over time.

Product Suite / Regulatory Compliance Management

Compliance Copilot

Conduct advanced searches, analyze complex data, and gain real-time summaries and visualizations that reveal insights beyond the obvious. Transform your compliance management with the power of AI. Seamlessly navigate complex regulations with our integrated data platform, natural language processing (NLP) query capabilities, and real-time insights.

Product Suite / Audit and Monitoring

Audit Management

Automate audit planning, execution, and reporting to save time and reduce errors. Ensure consistent compliance and operational transparency across all departments. Step up your audit game with our Internal Audit solution, designed to tackle the toughest challenges in health plan compliance. Elevate your organization’s compliance with new-age tools that turn audit headaches into operational wins.

Product Suite / Audit and Monitoring

Continuous Monitoring

Monitor key performance indicators continuously to gain actionable insights and make data-driven decisions. Enhance operational performance and reduce risks. Harness data for strategic insights and proactive risk management, ensuring high standards in compliance and operational efficiency. Say goodbye to inefficiencies and hello to data-driven excellence.

Product Suite / Audit and Monitoring

Audit Copilot

Automatically identify and log issues, provide real-time alerts, and suggest corrective actions. Streamline audit processes and achieve proactive risk management. Seamlessly navigate compliance with an integrated data platform, NLP query capabilities, and real-time insights. Transform your audit workflow and elevate your organization’s compliance game.

Product Suite / Healthcare Data Scrubbers

Universe Generation

Our experts help you transform raw, disparate data into CMS-compliant universes. Leverage our advanced specialized universe generation service to automate the creation of CMS-compliant universe files, ensuring accuracy, reducing manual effort, and enhancing operational efficiency. Our time-and-materials (T&M) approach ensures thorough compliance assessment and precise universe file generation tailored to your needs.

Product Suite / Healthcare Data Scrubbers

Universe Scrubber

Cleanse and validate your data in seconds with our powerful scrubbing tool with built-in compliance rules aligned with the latest CMS protocols to ensure your data is error-free and ready for audit. Transform your compliance process with automated on-demand scrubbing of authorizations, claims, appeals, and grievances to validate CMS universes (ODAG, CDAG, SARAG, CPE, FA, SNP-MOC, CCQIPE) and ensure your files are CMS-compliant.

Product Suite / Healthcare Data Scrubbers

Universe Aggregation

Combine multiple universe files into a single, compliant report with ease. Our aggregation tool ensures consistency and accuracy, reducing manual effort and enhancing submission reliability. Eliminate the potential for error when consolidating universe files manually. Intelligently aggregate multiple universe files scrubbed by different users during a specified period to generate a single CMS-compliant Universe file or table for submission.

Product Suite / Healthcare Data Scrubbers

Audit Copilot

Enhance your compliance strategy with our intelligent assistant. Universe Copilot provides real-time insights, guidance, and support, ensuring your data is always audit-ready. Enhance your compliance strategy with our intelligent assistant. Universe Co-Pilot provides real-time insights, guidance, and support, ensuring your data is always audit-ready.

Product Suite / Healthcare Data Scrubbers

Medicaid Log Scrubber

Take the complexity out of Medicaid data management by automating the scrubbing and validation of Medicaid logs to ensure your data is accurate, consistent, and compliant with state and federal regulations.

Product Suite / Healthcare Data Scrubbers

VBID Scrubber

Automate the validation and scrubbing of your Value-Based Insurance Design (VBID) data to align with CMS requirements effortlessly, ensuring that it is accurate, compliant, and ready for submission, reducing the risk of errors and penalties.

Product Suite / Healthcare Data Scrubbers

Call Log Scrubber

Go beyond the surface of call logs to identifying exactly what each call includes and flagging appeals or issues that need more attention to reduce potential non-compliance.

Product Suite / Healthcare Data Scrubbers

Data Scrubber

Simply align your data with the appropriate rules set, and the scrubber takes care of the rest. It ensures your data is not just compliant but also optimized for operational efficiency, enabling more accurate reporting and streamlined workflows across your organization.

Product Suite / Provider Relationship Management

Provider Dispute Resolution

Efficiently manage and resolve provider disputes to ensure timely resolutions, reduce administrative burdens, and foster transparent and collaborative relationships.

Product Suite / Provider Relationship Management

Potential Quality Improvement

Safeguard the quality of care within your provider network, ensuring that potential issues are addressed swiftly and effectively. By maintaining a high standard of care, you enhance member satisfaction and build a stronger, more reliable network.

Product Suite / Provider Relationship Management

Quality Improvement Organization

Streamline the QIO appeals, resulting in a more efficient, compliant, and transparent process that allows you to focus on delivering quality care and improving member experiences. Stay aligned with the QIO Program by using data to track healthcare quality improvements and address beneficiary complaints efficiently.

Product Suite / Provider Relationship Management

Provider CRM

Build and maintain strong relationships with your provider network. Centralize provider information, track interactions, and ensure personalized communication to enhance engagement and streamline administrative processes.

Product Suite / Provider Relationship Management

Healthcare Operations Copilot

Leverage advanced AI to strengthen your provider network. By automating routine tasks, providing real-time insights, and facilitating seamless communication, this AI-powered assistant ensures that you focus on building strategic partnerships, improving collaboration, streamlining provider interactions, and ensuring a high-performing network.

Product Suite / Delegation Oversight

Delegate/FDR Determination

Efficiently assess potential delegated entities with criteria-based preliminary evaluations. Ensure only qualified candidates proceed, reducing risk and enhancing compliance. Effortlessly filter and select the best delegates with precision. Delegate Determination ensures that only the most qualified entities make the cut, reducing risk and enhancing compliance from the outset.

Product Suite / Delegation Oversight

Delegate/FDR Repository

Securely store and manage all delegate details post-qualification. Keep comprehensive, up-to-date records accessible, simplifying oversight and audits. Keep all essential delegate information in one secure and easily accessible place to ensure that you stay organized and in control, simplifying oversight and audits.

Product Suite / Delegation Oversight

Delegate/FDR Audit & CAP

Conduct thorough audits of delegated entities to ensure adherence to contractual and regulatory requirements. Maintain high standards of compliance and mitigate risks effectively. Ensure effective oversight, streamline audit processes, and maintain regulatory compliance with ease. Transform your delegation management and safeguard your organization’s integrity with the latest technology solutions.

Product Suite / Delegation Oversight

Reporting & Monitoring

Leverage template-based data collection and analysis to monitor KPIs. Identify outliers and potential risks early, enabling proactive management and compliance assurance. Gain real-time insights and stay proactive with comprehensive reporting and monitoring. Keep track of delegate performance and compliance effortlessly with smart data analysis.