International Insurers Leverage the PLEXIS Platform to Deliver Better Care at Lower Costs

To increase your competitiveness in today’s expanding international market, successful insurers understand that you must deliver consistently higher-quality care at lower costs. International insurers adopt PLEXIS’ payer platform to enable centralized core administration, cost containment, comprehensive analytics, cultural-specific functionalities, enrollment, electronic workflows, and more. By leveraging the right tools, international payers enhance population health management while reducing enterprise-wide costs.

PLEXIS provides international insurers the right tools and technology, including:

  • Centralized core administration for multiple lines of business including major medical, fully-insured products, disability, life, travel assistance, and other benefits. Flexible functions are included for commission support and premium billing. Network management for multiple reimbursement arrangements allows you to enhance collaboration with providers and members.
  • Cultural-specific functionalities including member-centric customer service, support for multiple languages, multi-currency calculations, and portal access for clients, members, and providers
  • Cost containment solutions to help enhance quality of care and patient outcomes while significantly reducing utilization and costs. PLEXIS empowers you with business activity monitoring, automatic audits, incisive health risk assessments (HRAs), and responsive reporting
  • Quantitative analytics (BI/BA) to deliver predictive modeling and actionable intelligence to give you a competitive edge in total cost comparison.
  • Scalable electronic workflows: PLEXIS’ powerful EDI hub delivers enterprise-wide efficiencies with end-to-end workflows for claims, encounter data, provider portals, and more. Extensible functionality empowers payers to implement an enterprise data warehouse to track key performance metrics.
  • International enrollment including advanced enrollment services, foreign address support, and custom diagnosis and procedure codes. Enrollment options can capture unique fields such as country/region of origin, etc.
  • Meet complex compliance requirements: Accelerate growth while minimizing risk through end-to-end transparency and centralized premium and claim data. PLEXIS provides holistic visibility for compliance requirements from transfer pricing challenges to visibility over premium allocations.
  • Mobile solutions such as mobile access to ID cards, provider research, and health/news alerts/emergency info
  • Tools for transparency, oversight, and accountability, including fraud, waste, and abuse (FWA) detection, automated claim editing, and more.

Replacing legacy systems results in cost savings and enhanced capabilities

PLEXIS has over 14 years of experience implementing our integrated clinical, financial, and administrative payer platform for international customers in over fifteen countries. PLEXIS provides international insurers with agile solutions to modernize and grow in the business of healthcare.

PLEXIS often serves payers in Asia, MENA, the Caribbean, Latin America, and elsewhere. These payers are often replacing legacy system that do not support multi-currency calculations, handle only US claims, and cannot support custom diagnosis and procedure codes. By replacing these legacy systems, payers can reduce or eliminate manual data entry for claims, and greatly expedite claim processing and customer satisfaction. PLEXIS also has the expertise to create electronic import or export routines that use customized or standardized X12 EDI formats, which assist our clients in streamlining their processes, resulting in cost savings and a wide spectrum of added value for the payer’s organization.

Learn more about our work with Caribbean national health programs.