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HGS Healthcare Payer BPS

HGS Healthcare Payer BPS

Who Is This Vendor Assessment For?
NelsonHall’s profile of HGS’s Healthcare Payer Business Process Services (BPS) is a comprehensive assessment of service offerings and capabilities designed for:
• Sourcing managers monitoring the capabilities of existing suppliers to deliver business process services to healthcare payers
• Vendor marketing, sales and business managers looking to benchmark themselves against their peers
• Financial analysts and investors specializing in the support services sector.

Key Findings & Highlights
In the last five years, HGS has increasingly focused on serving healthcare clients and has grown healthcare revenue from $115m (FY 2014) to $360m (est. FY2019, ending March 31.) Over that period HGS has grown its healthcare practice from approximately one-quarter of total revenue (28%) to over one half of total revenue (53%). Currently, over 80% of HGS' healthcare revenue is generated by health plan clients, with 80% of that revenue generated by BPS contracts.
HGS supports over 30 health plans across medical, dental and pharmacy lines of business, including 3 of the top 5 health plans and nine regional BCBS health plans. HGS also serves Medicaid agencies. HGS has recently reorganized its Health and Insurance unit around:
• PDM
• Claims
• Payment integrity/FWA
• Quality/risk
• Clinical
• Coding
• Interaction services
• Revenue cycle management.
Claims processing remains a core capability as it has since HGS began serving BPS contracts for payers in 2000. Front office customer/member services are also core capabilities and central to revenue generation.
HGS' healthcare vertical employs 17,000 people, with nearly 15,000 serving healthcare payer BPS clients. Across all its verticals HGS employs 45,000 employees across 75 delivery centers in seven countries.
HGS is moving down-market from the national health plans where it has already established itself. HGS has begun to execute on this strategy by quadrupling the size of its salesforce and by leveraging relationships with smaller health plan clients gained through the 2018 AxisPoint Health acquisition.

Scope of the Report
The report provides a comprehensive and objective analysis of HGS’s offerings, capabilities, and market presence in support of business process transformation through the application of healthcare payer BPS including the company’s:
• Offerings and key service components
• Delivery organization
• Customer base, including the company’s targeting strategy and examples of current contracts (where available)
• Revenue estimates for healthcare payer BPS
• Strategy, emphasis and new developments in support of healthcare payer BPS
• Strengths, weaknesses and outlook.


1. Background
2. Revenue Summary
3. Key Offerings
4. Delivery Capability and Partnerships
5. Target Markets
6. Strategy
7. Strengths & Challenges
7.1 Strengths
7.2 Challenges
8. Outlook

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