Operations
Deliver a five-star
health care experience
When you work with enGen, you gain access to an operational team that services core functions of the member/patient health care experience. Through our powerful combination of technology and operations (TechOps), enGen provides a cohesive, efficient solution to delivery and processes across all lines of business.
What's Included?
Health Plan Operations
Our team of health plan operators service the core of member/patient experience: Enrollment and Billing, Benefit Solutions, Claims Excellence, Customer Service, and much more.
- 161M+ annual claims processed
- 9M+ annual ID cards mailed
- 4M inbound member calls and 2M+ inbound provider calls
Utilization Management
enGen’s Utilization Management (UM) experts support the entire Prior Authorization process for commercial, Medicare, and Affordable Care Act (ACA) health plans. With 2M+ authorizations a year, the UM team helps members receive high-quality care at the right place and at the right time.
Provider Data and Reimbursement
Our team of industry experts bridge the gap between payers, providers, and the people they serve. This team handles contract development and execution, credentialing, fee schedules, and policy creation.
Payment Integrity
Through accurate claims handling and administration, our team of payment professionals is experienced when it comes to creating an efficient, predictable payment process. This team works to reduce spend and design strategies that lead to better outcomes for all.