4 Challenges Blocking Intelligent, Scalable Payer Operations

Legacy processes, manual bottlenecks, and disconnected systems are costing payers more than they realize. This playbook shows how AI-powered intake and intelligent data validation help health plans improve accuracy, ensure compliance, and scale with confidence.

Takeaways:

  • Eliminate manual intake bottlenecks that create costly friction

  • Apply intelligent validation to improve data quality and prevent costly claim errors

  • Unify communications and reconciliation to reduce errors and delays

  • Connect support channels with automation to cut handle times and ease admin burden

Are Data Bottlenecks and Claims Delays Slowing You Down?

No health plan is perfect. But the more legacy systems, manual processes, and unstructured data you rely on, the higher the cost of inefficiencies across people, process, and technology.

This playbook helps you uncover:

  • The value of visibility–and accountability–across the entire payer lifecycle

  • How to create a foundation for scalability across all lines of business

  • Ways to optimize compliance enterprise-wide

  • Strategies to enhance member trust and loyalty through integrated communication and reconciliation channels

Top Opportunities to Optimize Payer Operations

  • “Overpaid claims are one of the most damaging outcomes of bad data. Once dollars go out the door, recovery is long, costly, and never 100%. That’s why improving data quality up front is the single most effective way to protect payers from both financial loss and member abrasion.”

    — Malcolm Smith, Vice President of Claims, Imagenet

  • In most states, health plans that fail to process claims within the state’s prompt-pay time period are required to pay interest to the provider, sometimes as high as 18 percent annually.

  • “Meeting prompt-pay requirements takes more than speed—it requires AI-powered, connected solutions across the entire claims lifecycle. With intelligent intake, AI-driven workflows, and seamless member communications, health plans can reduce waste, ensure compliance, and scale with confidence.”

    — Vidhya Bhat, Chief Product Officer of Digital Transformation, Imagenet

  • Call centers with lower wait times generate higher rates of loyalty. Customers who are satisfied with wait times are 3 times more likely to recommend a brand and 2.6 times more likely to trust a brand. — Customer Experience Dive

  • “Disconnected support channels don’t just slow down agents—they frustrate members and weaken trust. By unifying call center and digital interactions into a single view, and layering in AI for routing and compliance, we can help health plans cut handle times, reduce escalations, and protect Stars ratings while delivering a seamless member experience.”

    — Angie Lanasa, Senior Vice President, Operations, Imagenet

Get the Playbook. Build Future-Ready Operations.

Don’t let your inefficiencies become liabilities. Access actionable steps to optimize operations, control costs, and strengthen compliance.

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