EVALUATION: Customer Management Services in Healthcare Payer Support

General/Future Focus:
Vicki Jenkins, CMS Industry Analyst with NelsonHall, said “HGS currently provides a wide portfolio of offerings and is looking to the future as it supports its healthcare payer and provider clients. It is beginning to focus on the entire household of the patients/members. For example: high needs patients/members may have communication filtered to family members to ensure they do not miss an appointment or forget to take medication”.

Payer Back Office Capability:
Vicki Jenkins, CMS Industry Analyst with NelsonHall, said “HGS has demonstrated proven ability to improve claims processing for its healthcare payer clients. Its capabilities in fraud, waste, and abuse prevention, as well as payment integrity and financial recovery add to its strength and commitment to back office support for its healthcare payer clients”.


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A must-read for payer organizations looking to outsource customer management services (CMS), this latest NelsonHall vendor profile on HGS provides insight into the strategy that makes HGS a leader in healthcare CMS. Learn how HGS is working to create a holistic solution to enhance the customer experience with technologies and services that are consumer focused, while enabling revenue generation for its clients.

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As healthcare payers move to more consumer-centric, digitally enabled engagement, it's crucial that they have an outsourcing partner that can add value in the areas of people, process, and technology.

NelsonHall's new Customer Management Services Vendor Profile for HGS CMS in Healthcare provides insight into HGS key offerings, strategy, strengths, and challenges. This strategy is augmented by HGS's recent acquisition of Colibrium and its Tuo sales, service, and wellness platform, which creates a customized health risk assessment, and allows various health plan programs throughout the lifecycle of the member.

  • "Strong capability to support claims eligibility and claims processing for healthcare payers"
  • "Strong presence in healthcare payer sales and customer onboarding"
  • "Complementary capabilities in fraud, waste, abuse, and payment integrity and financial recovery"
  • "Proven ability for improvement regarding claims processing"