Canada
Puerto Rico
USA
Belgium
France
UK
India
Client Background
A leading not-for-profit US health insurer serving millions of members across diverse and underserved communities. The organization plays a critical role in delivering Medicaid, Medicare Advantage, and commercial plans through an extensive network of providers, with a mission rooted in equitable access and community health.
Client Need
The client needed a payment operations foundation that could scale with its growing member base. As the insurer scaled its operations, its legacy payment infrastructure became a bottleneck to efficiency and innovation. Key challenges included:
Limited real-time visibility into claims and payment status, resulting in delays and member/provider dissatisfaction
Fragmented systems and manual workflows, creating operational silos and increasing error rates
Inflexibility in handling diverse payment types, such as provider reimbursements, member refunds, and incentive payments
Heavy reliance on IT teams for exception handling, reconciliation, and compliance reporting
These issues not only strained internal resources but also impacted the insurer’s ability to meet regulatory demands and deliver a seamless experience to stakeholders.
Solution
Innova Solutions partnered with the client to modernize payment operations via a proactive, intelligent, and scalable
model that led to improved efficiency, compliance and better customer satisfaction. Innova built a modular, AI-enabled Payment Hub on AWS with:
model that led to improved efficiency, compliance and better customer satisfaction. Innova built a modular, AI-enabled Payment Hub on AWS with:
Configurable workflows for orchestrating EFTs, checks, and remittance generation
AI-powered EDI 835 file generation for automated remittance processing
Self-service portal for real-time payment tracking and status visibility
Automated reconciliation and acknowledgment tracking
Secure, scalable, and compliant architecture on AWS, leveraging services like Amazon S3, Lambda, and DynamoDB for resilient data processing
Unified platform for intake file processing, event management, and transaction oversight
End-to-end automation from ACH and check request generation to EOP delivery
Realized Benefits
The implementation of the Payment Hub delivered measurable and strategic outcomes:
85% reduction in manual interventions and faster exception resolution.
Accelerated payment cycles, improving cash flow and provider satisfaction
Enhanced transparency and user experience for via real-time insights
Audit-ready operations with automated logs and full traceability for compliance and governance
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