Claims & Membership Managed Services
Driving payer success through accurate processing, faster resolution, and better member experiences.
Smarter Claims.
Stronger Performance.
Inaccurate claims and fragmented processes don’t just disrupt your bottom line. They affect member satisfaction, provider relationships, and compliance risk. Health plans need a partner who can streamline claims and membership operations end to end, improve payment accuracy, and accelerate resolution without adding complexity.
Real Results. Real Impact.
+
metric efficiency for all health plans
in annual savings for clients from clinical and code reviews
reduction in out-of compliance cases through cognitive OCR solution
Sagility’s Claims and Membership Management Suite
Tech-led capabilities that help health plans manage claims and membership operations with greater accuracy, speed, and consistency.
Digital Mailroom
Accelerate claims intake with Sagility’s Digital Mailroom services. Intelligent ingestion and validation workflows convert incoming documents into clean, usable data, reducing backlogs and enabling faster downstream processing.
Product & Plan Configuration
Establish a clean foundation for accurate claims with Sagility’s Product & Plan Configuration services. We configure plans, benefits, pricing, and rules across core claims systems to support consistent adjudication and higher auto-adjudication rates.
Enrollment & Billing
Ensure member and financial accuracy upstream with Sagility’s Enrollment & Billing services. Healthcare-focused teams and AI-enabled workflows help health plans maintain eligibility integrity, prevent billing errors, and support smooth claims processing.
Adjudication & Adjustment
Improve core claims decisioning with Sagility’s Adjudication & Adjustment services. Technology-first workflows and deep payer expertise help resolve complex claims, minimize rework, and increase processing throughput at scale.
Appeals Management
Streamline post-adjudication resolution with Sagility’s Appeals Management services. Structured workflows and experienced teams help health plans meet turnaround requirements while improving accuracy and compliance.
Decades of Partnership, Performance, and Progress.
Clients stay with Sagility for a reason: deep-domain expertise, measurable outcomes, and a true partnership approach. Purpose-built for healthcare and trusted by the nation’s top health plans and providers, we bring decades of experience and a proven ability to simplify operations and deliver lasting impact.
Straight from the Source
We’re more than a vendor, we’re a partner. Here’s what our clients have to say:
The team has been exceptional. They are responsive, have great communication skills, and have helped us streamline our claims processing workflow. Their AI-powered solutions have significantly reduced our manual workload and improved accuracy rates across the board.
VP of Operations,
U.S. Fortune 100 health insurance company
Their innovative approach to revenue cycle management transformed our operations. We saw a 40% reduction in claim denials and a 30% improvement in processing speed within just three months of implementation.
Chief Financial Officer,
Regional hospital network
The implementation was seamless, and their support team is outstanding. We’ve achieved 98% accuracy in claims processing and reduced our days in A/R from 45 to 28. Their technology is truly game-changing for healthcare providers.
Revenue Cycle Director,
Multi-specialty physician group
Case Studies
See how we’ve helped payers unlock millions in savings and streamline operations:
Insights & Resources
Stay informed with the latest thinking on healthcare payer operations:
Ready to Work Smarter with Sagility?
Let’s explore innovative solutions tailored to your needs—and get more done, together.