Digital. Dynamic. Dependable.
Transform Member Experience Across Every Stage of the Journey
Redefine member engagement with seamless, personalized experiences. Resolve complaints, manage appeals, and ensure compliance using automation and AI. Deliver trust, transparency, and superior outcomes at every touchpoint.
“With Newgen’s solutions, we achieved a 154% increase in case processing efficiency that helped us process 5 million cases and save $20 million annually. Beyond the numbers, the real value was in the time saved and the reduction in errors, which directly impacted our bottom line.”
CTO, A Fortune 500 Healthcare Payer in the US
Built for Payers. Designed for Members.
Leverage our Complaints, Appeals, and Grievances Suite to build trust and loyalty with a member-first approach.
Go All-in on Interoperability with our Complete Product Pack or Choose Individual Modules
Member & Provider Appeals
Simplify the appeals process for members and providers with our solution. Leverage intelligent automation and end-to-end case management to handle appeals efficiently, ensuring fairness, accuracy, and compliance with regulatory timelines.
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External Review
Provide members with a transparent and seamless external review process. Automate submissions, manage communication with external agencies, and ensure timely, equitable resolutions for high-stakes appeals with our solution.
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Grievance & Complaints
Ensure every member’s voice is heard and resolved effectively. Automate the intake, categorization, and resolution of grievances and complaints while empowering payers to respond swiftly while maintaining a transparent audit trail for compliance.
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CTM
Leverage CTM module, interface with HPMS. Navigate Medicare-related complaints effortlessly. Track, document, and resolve cases seamlessly with our CTM solution, ensuring compliance with CMS guidelines, minimizing risk, and building member trust.
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Member Service Inquiries
Manage inquiries efficiently by leveraging the solution—built on NewgenONE—an AI/ML-driven, low code platform. Streamline request handling for information, assistance, or clarification from patients, providers, and stakeholders.
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Provider Disputes Management
Resolve provider claims seamlessly using the solution, built on NewgenONE—an AI/ML-driven, low-code platform. Simplify dispute management through automated workflows, enhanced data, and compliance checks.
Learn More >
Member & Provider Appeals
Simplify the appeals process for members and providers with our solution. Leverage intelligent automation and end-to-end case management to handle appeals efficiently, ensuring fairness, accuracy, and compliance with regulatory timelines.
External Review
Provide members with a transparent and seamless external review process. Automate submissions, manage communication with external agencies, and ensure timely, equitable resolutions for high-stakes appeals with our solution.
Grievance & Complaints
Ensure every member’s voice is heard and resolved effectively. Automate the intake, categorization, and resolution of grievances and complaints while empowering payers to respond swiftly while maintaining a transparent audit trail for compliance.
CTM
Leverage CTM module, interface with HPMS. Navigate Medicare-related complaints effortlessly. Track, document, and resolve cases seamlessly with our CTM solution, ensuring compliance with CMS guidelines, minimizing risk, and building member trust.
Member Service Inquiries
Manage inquiries efficiently by leveraging the solution—built on NewgenONE—an AI/ML-driven, low code platform. Streamline request handling for information, assistance, or clarification from patients, providers, and stakeholders.
Provider Disputes Management
Resolve provider claims seamlessly using the solution, built on NewgenONE—an AI/ML-driven, low-code platform. Simplify dispute management through automated workflows, enhanced data, and compliance checks.
Low Code Solutions with Accelerator Products
Newgen’s accelerator products are interconnected components designed to fast-track your development projects. With extensive R&D already invested in the foundational elements, these products serve as a ready-to-use base. Developers—yours or ours—can customize them to meet your unique requirements. Together, we deliver a tailored solution quickly, ensuring the final product aligns seamlessly with your timeline and goals.
Member Portal
Empower members with instant access to information, enhancing convenience and engagement
Insurance Sales & Member Mobile Enrollment App
Optimize processes, eliminate paper-based transactions, and capture member information in a frictionless manner
Enrollment Case Management
Optimize enrollment with an automated, customized system while improving accuracy
Premium Billing
Streamline the end-to-end process while enhancing precision and overall accuracy
Sales & Retention
Boost sales and retention with an AI-driven, automated system while gaining real-time insights into the process
Success Stories
Key Benefits
- Leverage Ready-to-use, Highly Configured Solutions: Access solutions pre-configured with hundreds or thousands of business rules, allowing you to streamline processes from day one
- Reduce Implementation Time: Minimize integration and customization time for faster deployment, getting your systems up and running with minimal disruption
- Prepare for the Future with Scalable Technologies: Adopt scalable, modular solutions that address current challenges and evolve with your health plan’s future needs
- Drive Innovation and Member Experience: Benefit from continuous innovation to provide members with the best possible experience while maintaining efficiency and compliance
Value-added Products for the Member Journey
Health Plan Mailroom & Content Intelligence
Quality Monitoring and Audit
Regulatory Tracking & Response
Health Plan Regulatory Reporting and Business Intelligence
Health Plan Process Improvement & Root Cause Analysis
Payer Operations Business Process as a Service with AI, ML & RPA
NewgenONE Leverages the Built-in Capabilities of 4 Primary Platforms
Newgen Delivers Fast Time-to-value
Forrester analyzed the Total Economic Impact™ of Newgen and its low code and cloud-based platform
371 %
return on investment
$29 Mn+
value generated
6 Months
payback
Find Your Winning Strategy with Newgen
Request a demo to explore our solutions for the Payer-Member Journey.
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