Managed Outcomes
Member & Provider Management Services
Zyter Member Management Services specializes in healthcare member management solutions that help payers, providers, and government programs deliver better care experiences while optimizing operations. Our team supports every stage of the member lifecycle—from enrollment and eligibility verification to care coordination, issue resolution, and retention.
Payer BPO Service Offerings
Our Payer BPO services are designed to help health plans operate more efficiently, improve member and provider satisfaction, and maintain compliance in an evolving regulatory landscape.
BPO-Specific Offerings
- Claims intake
- Claims adjudication
- Billing
- COB processing
- Appeals resolution
- Claims audit Fraud Mitigation
- L0-L1 application helpdesk
- Analytics support
Enabling Solutions
- Claim Management Platform
- End-to-end claims
- Operations
- Effectiveness Management
BPO-Specific Offerings
- Provider setup and maintenance
- Credentialing
- Contract management
- Pricing, configuration
- Fee schedule loading
- Provider support services
- L0-L1 application helpdesk
- Analytics support
Enabling Solutions
- Establishing omni-channel contact center operations
- Analytics engine for provider performance, network adequacy assessment, and PCMH
BPO-Specific Offerings
- Enrollment and eligibility
- Renewal and termination
- Member maintenance
- Premium billing and reconciliation
- Member support services
- L0-L1 application helpdesk
- Analytics support
Enabling Solutions
- Establishing omni-channel contact center operations
- Analytics framework for retaining and recapturing potential members on attrition
BPO-Specific Offerings
- Plan setup/case installation
- Product/site addition
- Plan renewal
- Contract drafting
- Benefit coding
- L0-L1 application helpdesk
Enabling Solutions
- Accelerator to automate generation of claims-based test cases for testing benefit coding.
BPO-Specific Offerings
- Prior authorization
- Complaints/appeals triage
- Medical necessity reviews
- Member satisfaction surveys
- Outreach support
- L0-L1 application helpdesk
- Analytics support
Enabling Solutions
- 24/7 Nurse Triage
- Increased efficiencies via a streamlined utilization, case and disease management experience.
- Engage members to manage chronic conditions effectively and improve overall health status.
- Advanced analytics solution to improve clinical outcomes.
Additional offerings
Digital mailroom
Global workforce
Claims processing
Analytics & reporting
Digital platforms
Robotic process automation
AI/ML intelligent automation
We bring together AI innovation and operational rigor to reimagine how BPO services deliver value
We bring agentic AI to every touchpoint
Enabling built-in intelligence to enhance efficiency, experience, and oversight
Reporting & Analytics
We utilize real-time reporting and deep root-cause analysis to pinpoint operational inefficiencies as they happen. By identifying and eliminating bottlenecks at the source, we ensure recurring issues are resolved and overall performance is continuously optimized.
Workload Optimization
Our system provides real-time visibility into operational workflows to highlight delays and drive rapid improvements. This proactive approach ensures that resources are allocated effectively to eliminate process friction and maintain consistent service delivery.
Data Management
We streamline data operations by automatically converting unstructured information into structured, actionable formats. Our intelligent tools proactively identify and correct data errors, ensuring high levels of accuracy and integrity across all enterprise systems.
Document Processing
Leveraging enhanced OCR technology, we automate the intake of complex documents, such as prior authorization faxes. The system incorporates automated compliance checks to accelerate processing times while maintaining strict adherence to regulatory standards.
Back Office Automation & Decision Support
By integrating RPA and machine learning, we automate complex back-office transactions and administrative tasks. The platform provides proactive, suggested solutions for intricate cases, empowering staff with intelligent decision support to increase accuracy and speed.
Member & Provider Services
We enhance engagement through intelligent chatbots and virtual assistants that handle routine member queries and provide real-time claim status updates for providers. This automation ensures 24/7 availability while freeing human agents to focus on high-value interactions.
Contact Center Automation
Our AI-powered CCaaS platform optimizes call routing and utilizes virtual agents for immediate FAQ resolution. This orchestration reduces wait times and improves the overall user experience by ensuring every interaction is handled by the most efficient resource.
Process Automation
We drive operational excellence by automating core processes like prior authorization and claims handling through intelligent workflows. By syncing fax and secure message automation, we reduce manual touchpoints and accelerate the path from request to resolution.