WE ASSIST
HEALTHCARE
Optimized care & protection
Rulesware streamlines healthcare insurance with cost-effective solutions, automating enrollment, claims, and authorizations. Boost performance and enhance customer experience through personalization and digital efficiencies.
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Sophisticated Group Quoting
Enhanced group quoting isn’t just a perk—it can be a game-changer for healthcare software companies. Let us show you.Â
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Optimized & Connected Provider Networks
Rulesware helps organizations through the meticulous selection and management of network providers, healthcare institutions can elevate access to care, foster collaboration among providers, and enhance the efficiency of care delivery.Â
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Advanced Enrollment
Rulesware helps your patients access care without delays, enjoying a hassle-free experience, and swiftly securing their benefits and coverage.
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Autonomous Claims Handling
By optimizing and automating workflows, healthcare organizations can significantly improve efficiency and reduce administrative burdens associated with claims management.Â
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Automated Care Management
Rulesware helps Healthcare providers leverage automation technology, so they can streamline administrative tasks, such as appointment scheduling, patient data management, and care coordination, freeing up valuable time for clinicians to focus on delivering high-quality patient care.Â
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Optimized Call Center Operations
Investing in the best call center software isn’t just smart—it’s essential for healthcare organizations to deliver top-tier patient care and stay ahead of the curve in today’s competitive landscape.Â
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AI Driven Back Office
Back-office automation serves as a catalyst for operational excellence, cost optimization, regulatory adherence, and elevated patient care standards in a fiercely competitive environment.Â
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Better Business Outcomes
In the healthcare sector, superior business outcomes vital for success. Investing in the right software can revolutionize operations, ensuring healthcare organizations not only survive but flourish in today’s ever-evolving landscape.Â
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Optimized Architecture
We provide Healthcare organizations with the power of optimized architecture. By investing in the right framework, healthcare organizations can create software that not only meets today’s needs but also adapts to whatever the future holds.Â
SOPHISTICATED
GROUP QUOTING
Rulesware assists our clients in streamlining their group quoting process, starting from the initial briefing and extending through approval, distribution, and monitoring. Establishing a standardized process is crucial for ensuring transparency, accuracy, collaboration, and timeliness. Managing transparency during the drafting, revising, and finalizing stages of the quote requires specialized handling and processing. Utilizing technologies and processes that seamlessly integrate with policy administration systems is highly recommended for optimal efficiency.
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services
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Success STORY
End-to-End Group Quoting Process
A payment processing client needed a global contact center and disputes application for handling transactions while navigating financial compliance rules from more than 100 countries.
OPTIMIZED & CONNECTED
PROVIDER NETWORKS
We help you specialize in optimizing provider networks through innovative technology and strategic partnerships. Our solutions leverage data analytics to help identify high-performing providers, negotiate favorable contracts, and enhance network efficiency. We also have experience and offer tools for provider credentialing, performance monitoring, and network expansion. Â
We help our clients manage costs and maximize the value delivered to their members and providers. This strategic approach grants them a competitive edge in the market.Â
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services
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Solutions
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Success STORY
Not-For-Profit Health Insurance Company
Transformation of expensive, unscalable, error-intensive manual processes with digital automation in order to strengthen their relationships with their Provider network(s).
ADVANCED
ENROLLMENT
Rulesware is at the forefront of the industry in Pega Enrollment Implementations, enabling you to accelerate enrollment processes for your end users.Â
We enhance profitability and operational flexibility for forward-thinking enterprises. Leveraging our expertise, we optimize enrollment procedures, design engaging customer journeys, and deploy cutting-edge automation solutions, allowing you to prioritize what’s essential for your members.Â
Empower your customers with state-of-the-art digital tools customized to address their insurance requirements in today’s competitive markets, ensuring sustained business growth and expansion both presently and in the future.
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services
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Solutions
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Success STORY
Medicaid Enrollment Automation Streamlines The Member Journey
Overcoming the challenges of an efficient, customer-centric enrollment for Medicaid.
Autonomous
Claims Handling
We have helped many of our healthcare clients manage and optimize their claims processes in order to help reduce their claims costs and leakage due to improper claims adjudication. Â
At Rulesware, we offer cutting-edge automated claims processing services and solutions designed to expedite the entire claims lifecycle.Â
Our advanced technology automates tedious tasks such as: claim submission, verification, adjudication, repair, payment processing, and error minimization. With our solutions, you’ll experience faster claims resolution, reduced administrative burden, and improved accuracy, ultimately enhancing your bottom line.Â
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services
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Solutions
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Success STORY
Pharmacy Claims Processing
Intake automation for a pharmacy client whose primary business was processing claims for health insurers, employers, individuals and seniors on Medicaid.
Automated
Care Management
At Rulesware, we specialize in helping Healthcare organizations implement care management automation solutions designed to streamline care coordination, enhance patient engagement, and improve care quality. Our solutions help you integrate with electronic health records (EHRs), population health management systems, and other healthcare IT systems to provide a holistic view of patient health and care history. With automated workflows, proactive alerts, and analytics capabilities, our solutions have empowered care teams the ability to deliver personalized, evidence-based care while maximizing efficiency and resource utilization.
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services
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Solutions
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Success STORY
Non-Profit Care Management Services
Managing manual processes for a non-profit organization providing professional care services and financial assistance to patients, with serious health conditions.
OPTIMIZED
CALL CENTER operations
At Rulesware, our expertise lies in crafting cutting-edge applications tailored for call centers. We prioritize the development of intelligent call routing systems and seamless integration with CRM platforms. Our solutions equip agents with extensive customer data and history, facilitating personalized interactions and swift issue resolution. Additionally, they establish a robust framework for transparent and timely handling and management of service cases.Â
The best call centers have Pega, and have been implemented by Rulesware – let us show you.Â
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services
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Solutions
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Success STORY
Health Insurance and Pega Re-Architecture
After investing in Pega and two years of work, a US-based health insurer enlisted Rulesware to upgrade and re-architect their call center solution.
AI Driven
BACK OFFICE
At Rulesware, we recognize that efficient back-office operations and automation within it are crucial for achieving overall business success. That’s why we provide cutting-edge back-office automation services tailored to streamline your administrative processes and supercharge productivity.Â
Our advanced technology automates repetitive tasks, optimizing workflows, and eliminating manual errors. With our back-office services, you’ll experience increased efficiency, enhanced accuracy, improved scalability, and significant cost savings.Â
Let us revolutionize your back-office operations and propel your business to new heights of success. Partner with Rulesware and unleash the full potential of your system applicators.
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services
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Solutions
- Blue Shield of California (IWM)
- Onboarding fallouts and handling.
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Success STORY
Onboarding Fallouts & Handling.
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BETTER
BUSINESS OUTCOMES
We take pride in delivering the best business outcomes for our clients through our engagements. Whatever your problem areas or needs may be, we’ll work with you to define targets and execute strategies to meet them. Our commitment extends to measuring progress against results, providing you with peace of mind that you’re achieving the outcomes you expect.Â
With Rulesware you get optimal delivery of your solutions with enhanced effectiveness and efficiency in processes, resulting in superior business outcomes.Â
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services
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Solutions
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Success STORY
Rulesware's Pega Expertise Takes Palomar Growth to the Next Level
Client was not deeply experienced with Pega, was on the other side of the globe, and was providing code that wasn’t up to their high standards.Â
OPTIMIZED
ARCHITECTURE
At Rulesware, we are dedicated to developing top-notch applications for our clients, utilizing the right architecture and design to guarantee consistent, dependable performance, even during idle periods. We’ve supported healthcare organizations in transitioning to cutting-edge architectures that directly enhance and optimize performance, scalability, and security.Â
Our teams possess a deep understanding of application design and its interplay with infrastructure, allowing us to optimize both elements for seamless integration. We have a proven track record of assisting our clients in achieving optimal application uptime and resilience, and we’re ready to extend our expertise to help you achieve the same.Â
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services
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Solutions
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Success STORY
Health Insurance and Pega Re-Architecture
After investing in Pega and two years of work, a US-based health insurer enlisted Rulesware to upgrade and re-architect their call center solution.
