CRUX Health Payer Suite

Pre-built modular solutions for healthcare payers

Streamline operations, Improve efficiencies and combat soaring complexity with our readily configurable payer solutions

Core administration solutions as Plug & Play modules

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Data Protection: ISO 27001:2013 certification

HIPAA compliant software solutions

CRUX Health payer suite is the result of our deep industry expertise and our work over the last decade with leading healthcare payers in alleviating several of their major pain points. Our cloud based health plan suite offers real-time integration of various enrollment channels and facilitates cost-effective execution of health plan operations. It’s time to benefit from our highly configurable modular solutions for enrollments, member maintenance & billing to greatly simplify your health plan operations.

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Implementing HIX for Leading Insurance provider

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CRUX Enrollment

Simplify multi-channel enrollments, Improve accuracy & Gain transparency with GGK’s CRUX Enrollment Solution

CRUX Enrollment Solution validates and determines eligibility across channels based on configurable business rules. The automated workflow system then tracks the exceptions and populates the work queues while the exception free enrollments are automatically processed. Now you can easily standardize and consolidate multi-channel enrollments without costly changes to core systems.

Key Features:

  • Automated processing of enrollment applications across multiple channels (Online, Data entry, CSR, HIX integration)
  • Eligible members are directed to marketplace through CMS Integration
  • Eligibility determination based on Configurable Business Rules
  • Automated exception handling workflow system
  • Fulfilment and ID Card Generation
  • Reports & Dashboards for end to end visibility

CRUX Member Services

Simplify member management, Improve retention, and scale as you go with CRUX Member Services Solution.

CRUX Member Services Solution provides a robust platform for payers of any size to efficiently manage ongoing member operations and service requests. Powered by a configurable business rules engine, CRUX Member Services solution enables a wide range of service operations that brings down the cost and improves the service levels.

Key Features:

  • Highly Configurable Business Rules Engine
  • Member Information Maintenance
  • Policy and Agent Maintenance
  • Policy Reinstatement and Subsidy Management
  • Multi-channel communication with members and agents
  • Plugs & plays with any portal solution

CRUX Billing

Fully automate invoicing, eliminate manual work and improve accuracy with highly configurable CRUX Billing Solution.

CRUX Billing Solution helps you configure premiums, automate invoices and process payments while providing a great level of flexibility and accuracy. With inbuilt features to automatically process refunds, reconcile premiums and handle delinquencies, CRUX  billing solution significantly lowers the cost of operations & improves efficiency for payers of any size.

Key Features:

  • Timely correspondence to members regarding payments
  • Acceptance of payments and statement generation
  • Automated processing of Delinquencies, Refunds, Transfers, Removals & Premium Adjustments
  • Commission Management
  • Generation of Financial and Executive Reports
  • Cash and Subsidy Reconciliation

CRUX Portals

Empower your members & agents, reduce administrative burden & communicate efficiently with CRUX Portals.

CRUX self-service portals for members and agents seamlessly integrates with the member services solution or any other core administration systems to enable self-service functionalities. These secure portals enable superior quality of service to stakeholders while bringing down the operational cost drastically.

Key Features:

  • Member and Agent Portals
  • Intuitive User Interface
  • Multi Device Support
  • Seamless Integration with other administrative solutions

Self Service BI

Our Self Service BI solution helps you unleash the actionable insights hidden in your data.It also helps you to visualize your data by discovering the hidden patterns, intuitively explore, and democratize the data in order to drive better business decisions.

Key Features:

  • Payer Specific Dashboards
  • Drag and Drop Interface
  • Ad-hoc Reports
  • Advanced Visualizations
  • Report Subscriptions

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