Protiviti’s Healthcare Industry specialists partner with healthcare payers to manage risk and improve the efficiency and effectiveness of their operations and compliance activities. Whether your top concern is payment reform, regulatory compliance, improving revenue, managing costs, evaluating and safeguarding protected health information, or leveraging new technology, Protiviti brings deep industry knowledge and skill to help healthcare organizations manage risks and maintain their financial health.

From members, employers and providers to regulators and investors, healthcare payers have to delicately balance the competing demands of their many stakeholders to succeed. They must develop and deliver innovative solutions and seamlessly manage a business that involves frequent change. And they must identify and manage the business risks associated with this dynamic environment.

At Protiviti, we are in the business of developing and delivering innovative solutions. We know how to manage change effectively and efficiently. And we are leaders in risk management. We partner with our health plan clients to bring deep skills and proven methodologies to bear on the problems that matter. In doing so, we help our clients gain a competitive advantage and satisfy the competing demands of their many stakeholders.

Information and Data: We understand the criticality of information, as well as the systems necessary to accumulate, manage and report massive amounts of data. Our capabilities allow us to bridge the gap between information technology (IT) and the business to make improvements in areas such as Project Governance, Performance Metrics and Analytics, IT Organizational Effectiveness, and Information Security and Privacy.

Governance, Compliance and Risk: Effective communication and oversight are essential in meeting stakeholder demands. Protiviti has the methodologies, tools and capabilities to help make incremental improvements in areas including Internal Audit, Regulatory Compliance, Enterprise Risk Management, and Model Audit Rule or Sarbanes-Oxley Compliance.

Operations and Finance: As a health plan’s products and services evolve, so too must the processes that support the business. We offer a wide variety of solutions in areas such as Financial Process Optimization, Revenue Recognition and Reconciliations, Spend Analysis and Procurement Streamlining, and Claims Cycle Effectiveness.