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Solutions Across the Healthcare and Insurance Value Chain

Explore our capabilities, tailored to your organisational role, operating model and level of value-chain control.​

Insurers, MGAs & Captives: Controlled Operating Improvement

Pain Points

  • Medical inflation and inefficient care put severe pressure on premiums, funding and margins.

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  • Members struggle with eligibility, provider choice, coverage understanding and pre-authorisation friction.

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  • Claims administrators may apply rules, pricing and service standards inconsistently.

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  • Underwriting and medical selection slow customer acquisition and onboarding.

Hexilis Response

  • Real-Time Care Navigation & Network Cost Containment

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  • Claims Administrator Performance Audit & Oversight

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  • Digital Medical Selection & Underwriting

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  • Coverage & Benefits Assistant grounded in structured rules

Outcomes

Lower avoidable medical spend, reduced out-of-network leakage, faster member servicing, stronger claims oversight and improved underwriting efficiency.

TPAs & Claims Administrators: Throughput, Consistency & Quality

Pain Points

  • Multiple plans, exclusions, limits and procedures create high operational complexity.

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  • Manual rule interpretation drives inconsistency, rework and avoidable escalation.

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  • Insurer clients demand total transparency on SLAs, adjudication accuracy and leakage.

Hexilis Response

  • Map claims workflows, bottlenecks and rework drivers.

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  • Structure plan and adjudication rules into controlled operational logic.

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  • Define KPIs, audit methodologies and remediation priorities.

Outcomes

Lower manual effort and rework, consistent rule application, SLA transparency, and the ability to scale processing volumes without proportional headcount growth.

Brokers & Distributors: Commercial Performance & Servicing

Pain Points

  • Comparing products and plans across multiple carriers is complex and time-consuming.

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  • Paper or PDF medical questionnaires create sales friction during onboarding.

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  • Intensive client servicing on coverage and claims erodes distribution margins.

Hexilis Response

  • Digital distribution and plan comparison support.

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  • Digital medical selection workflows during sales.

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  • Coverage and benefits assistance for client servicing and employee education.

Outcomes

Faster quoting and onboarding, consistent client service, reduced administrative burden, and improved conversion and renewal rates.

Medical Providers: Workflow Efficiency & Revenue Protection

Pain Points

  • Clinical, administrative, billing and communication workflows are fragmented.

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  • Eligibility and pre-authorisation checks create friction at the front desk and payment uncertainty.

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  • Payers frequently query, reject, delay, or underpay invoices.

Hexilis Response

  • Provider operating model and workflow redesign.

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  • Connected clinic operating platform implementation.

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  • Pre-submission billing control and retrospective revenue cycle audit.

Outcomes

Cleaner workflows, fewer coverage surprises for patients, higher clean-claim ratios, lower revenue leakage and improved cash flow.

HealthTech & InsurTech Companies: Local Market Traction

Pain Points

  • Product-market fit doesn't automatically transfer across international borders.

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  • Local buyer needs, regulations, and procurement processes are not well understood.

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  • Pilots fail when economics, workflows, and implementation requirements aren't validated.

Hexilis Response

  • Market assessment, entry scenario ranking, and outsourced commercial development.

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  • Local use-case definition and value proposition adaptation.

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  • Partner mapping, qualification and go-to-market execution support.

Outcomes

Faster market validation, reduced entry risk, sharper local positioning and direct access to local healthcare/insurance buyers.

Insurance Distribution & Operations Heads: Commercial Performance, Operational Excellence & Risk Control

Pain Points

  • High lead costs, low conversion, and inconsistent agent performance hurt sales networks across dispersed markets.

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  • Manual claims and complex annual renewal cycles increase operational expenses and error rates.

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  • Disconnected CRMs and missing Single Customer Views block effective segmentation, contact optimisation, and omnichannel attribution.

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  • Unscreened acquisition funnels expose portfolios to online fraud, low persistency, and high claims loss ratios.

Hexilis Response

  • Deploy speech analytics, automated sales coaching, CRM workflows, and compliant distribution frameworks to boost agent productivity.

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  • Align matrixed stakeholders and redesign customer touchpoints to improve service quality and First-Contact Resolution.

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  • Establish data governance and predictive modelling for customer segmentation, lifetime value, persistency, and fraud detection.

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  • Execute Lean Six Sigma reviews, expand claims automation, eliminate waste, and manage high-volume renewal cycles.

Outcomes

Higher agent sales productivity, lower lead acquisition costs, measurable turnaround in portfolio IRR, reduced claims loss ratios through fraud prevention, and streamlined operational processing across high-volume customer portfolios.

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