BPO
Member Management Services
Zyter Member Management Services specializes in healthcare member management solutions that help payers, providers, and government programs deliver better care experiences while optimizing operations. Our team supports every stage of the member lifecycle—from enrollment and eligibility verification to care coordination, issue resolution, and retention.
Payer BPO Service Offerings
Our Payer BPO services are designed to help health plans operate more efficiently, improve member and provider satisfaction, and maintain compliance in an evolving regulatory landscape.
Claims
Management
BPO-specific Offerings
- Claims intake
- Claims adjudication
- Billing
- COB processing
- Appeals resolution
- Claims audit Fraud Mitigation
- L0-L1 application helpdesk
- Analytics support
Point Solutions
- Claim Management Platform
- End-to-end claims
- Operations
- Effectiveness Management
Provider/Network Management
BPO-specific Offerings
- Provider setup and maintenance
- Credentialing
- Contract management
- Pricing, configuration
- Fee schedule loading
- Provider support services
- L0-L1 application helpdesk
- Analytics support
Point Solutions
- Establishing omni-channel contact center operations
- Analytics engine for provider performance, network adequacy assessment, and PCMH
Member
Management
BPO-specific Offerings
- Enrollment and eligibility
- Renewal and termination
- Member maintenance
- Premium billing and reconciliation
- Member support services
- L0-L1 application helpdesk
- Analytics support
Point Solutions
- Establishing omni-channel contact center operations
- Analytics framework for retaining and recapturing potential members on attrition
Plan/Benefit
Management
BPO-specific Offerings
- Plan setup/case installation
- Product/site addition
- Plan renewal
- Contract drafting
- Benefit coding
- L0-L1 application helpdesk
Point Solutions
- Accelerator to automate generation of claims-based test cases for testing benefit coding.
Care
Management
BPO-specific Offerings
- Prior authorization
- Complaints/appeals triage
- Medical necessity reviews
- Member satisfaction surveys
- Outreach support
- L0-L1 application helpdesk
- Analytics support
Point Solutions
- 24/7 Nurse Triage
- Increased efficiencies via a streamlined utilization, case and disease management experience.
- Engage members to manage chronic conditions effectively and improve overall health status.
- Advanced analytics solution to improve clinical outcomes.
Digital
Mailroom
Claims
Processing
Robotic Process Automation
Global
Workforce
Analytics &
Reporting
AI/ML Intelligent
Automation
Digital
Platforms
Digital
Platforms
Digital
Platforms
We bring together AI innovation and operational rigor to reimagine how BPO services deliver value
Unified service hub with omnichannel interaction
Omnichannel Collaboration (Self service, bidirectional connectivity, voice, chat)
Unified CRM &
UM/CM Front-End
Predictive engagement & automated issue resolution
Proactive Outreach &
AI Predictive Engagement
Contact
Automation
AI-driven decision support for customers & agents
AI-driven decision support
for customers & agents
Agent Assist &
Co-Pilot
Personalized Decision
& Next Best Action
Reengineered processes and optimized workforce
Operational Excellence & Predictive Workforce Management
Process
Re-engineering
Employee
Engagement
We bring agentic AI to every touchpoint
Enabling built-in intelligence to enhance efficiency, experience, and oversight
Reporting & Analytics
- Real-time reporting to highlights inefficiencies and drive improvements quickly
- Root cause analysis to eliminate bottlenecks and recurring issues
Workload Optimization
- Real-time reporting to highlights inefficiencies and drive improvements quickly
- Root cause analysis to eliminate bottlenecks and recurring issues
Data Management
- Conversion of unstructured to structured data
- Data error identification and correction
Document Processing
- Enhanced OCR intake, such as for prior auth faxes
- Compliance checks
Back Office Automation
&
Decision Support
- Technologies like RPA, AI, and machine learning for back office automation
- Proactive suggested solutions for complex transactions
Member &
Provider Services
- Chatbots for routine member queries
- Virtual assistants to give providers real-time claim status updates
Contact Center Automation
- AI-powered CCaaS (Contact Center as a Service) and routing optimization
- Chatbots & virtual agents for FAQs
Process Automation
- Intelligent automation of prior authorization, claims processing, and other core processes
- Fax/secure message automation