Services

Call Center, Back Office and Consulting

Convey can handle all of your plan’s member management needs.

At Convey, our call center and back-office professionals are not just trained to offer exemplary service, they are specifically trained to support government-sponsored health plans.

Our expert and empathetic representatives can handle all of your plan’s member management needs, both year-round and seasonal.

5

Inbound Member Services

Fulfillment requests, Rx order status, change of demographic information, formulary compliance, premium billing, claims inquiries, referral requests, provider network search, plan changes.

5

Provider Customer Service

Claims status and discrepancies, plan benefit explanation, eligibility requests, quantity limits validation, prior approvals intake, evidence of coverage.

5

Coverage Determination & Appeals

Field inbound calls from members and member representatives, initiating forms, triaging requests, managing provider and pharmacy communications.

5

Telephonic Licensed Enrollment

Compliant Medicare, I-PDP and ACA  sales, avoids regulatory exposure due to non-compliant enrollment, steers members to the most suitable plan, state-licensed sales representatives.

5

Grievance Processing

Grievance telephonic intake, distinguish grievances from general inquiry, reduced time frame for grievance closure, improved CMS compliance, overall reduced grievances filed.

5

Enrollment Processing

Processes paper enrollment and electronic enrollment, accurate application results, MARx reconciliation, incomplete application processing, minimized retro enrollment.

5

Outbound Campaigns

Outbound list validation, high contact rates, reduced inbound calls to member services, dialer optimization, promotes improved Star Ratings, comprehensive reporting, member surveys.

5

Offline Enrollment Processing

Processing paper and electronic enrollments, incomplete application processing, minimizing retro enrollments.

Gorman Health Group can help you excel within your government-sponsored health programs.

Gorman Health Group offers unique, hands-on expertise combining innovation with proven, integrated approaches and technology solutions to ensure your plan is successful, your provider partners are engaged and aligned, and your members stay happy and loyal. Whether it is a clinical redesign, risk adjustment, effective compliance programs, or monitoring operations performance in real time, Gorman Health Group delivers lasting results.

Gorman Health Group’s elite consulting services and technology solutions are built to exceed industry best practices and support your organization in maintaining compliance, improving quality, and optimizing revenues. They offer one-stop access to expert advice, guidance, and support in every strategic and operational area.

5

Compliance

5

Provider Strategies

5

Star Ratings & Quality Innovations

5

Pharmacy & Clinical Solutions

5

Healthcare Analytics & Risk Adjustment Solutions

5

Operational Performance

5

Sales, Marketing & Strategy

Why We Are Different

We are solely focused on healthcare – our services are
built-for-purpose. And with compliance and quality, our organizational operations mirror and align with that of the health plan.

We are able to effectively and cost-efficiently manage your members, while maintaining focus on their member experience.

Questions?

Contact one of our sales representatives to learn more.
They will quickly get you in touch with the subject matter experts and ensure your detailed questions are answered.

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