Operations and administration

Streamline operational processes and reduce administrative expenses

Health plans are under pressure to operate more efficiently, accelerate new business models, achieve regulatory compliance and transform their operations. Modern technology, nimble operating models and advanced analytics are required to remain competitive.

Optum offers business and technology consulting, services and software aimed at reducing the complexity and cost of health plan operations, meeting compliance requirements, supporting new business models and positioning the plan for growth opportunities. Solutions include:

Administrative cost optimization

Adapt, evolve and thrive in a regulated post-reform era

Heath plans are challenged to support increased regulations, consumer-centric models, new technologies and aging, more chronic populations. Optum helps health plans adapt, evolve and thrive in a modern, post-reform era with a focus on automation, optimization and innovation. 

Regulatory compliance

Comply, adapt and grow in the post-reform era

Health plans are faced with an unprecedented increase in reform and regulations. Optum has unparalleled experience and a suite of compliance solutions to help meet these reform and compliance goals.

Core administration

Transform operations to remain competitive, enable quality and support growth

Health plans have considerable opportunities to remove costs from their current operations. They also have significant growth opportunities if they can reposition their business model to be scalable, flexible and quality-driven at the core — with the ability to profitably support new populations and drive innovation in high-impact arenas of clinical integration and product innovation.

Optum offers core administration solutions aimed at reducing administrative costs, containing claims costs and improving strategic services that support growth and enable evolving risk- and quality-based business models.

Payment integrity

Simplify systems to reduce costs and increase accuracy

We proactively drive payment accuracy, improve provider relationships and enhance member experience. Our solutions transform end-to-end claims processing performance by simplifying the payment system, improving accuracy and reducing costs.

Health payment solutions

Bring electronic data and banking functions together

Optum helps simplify and streamline the claims payment process for payers and providers. With a network of more than 1,000,000 providers, we offer a total payment and remittance solution that includes electronic funds transfer (EFT), virtual card payment (VCP) and electronic remittance advice (ERA). Our solution can significantly reduce administrative costs for individual payers and across the entire health care system, while improving service to and relations with providers in a payer’s network.

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An Optum professional will contact you within one business day. If you have additional questions, please contact us at 1-800-765-6807 or empower@optum.com.