Protiviti’s Healthcare Industry specialists partner with healthcare payers to manage risk and improve the efficiency and effectiveness of their operations and compliance activities.

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 also in the business of developing and delivering innovative solutions. We know how to effectively and efficiently manage change. And we are leaders in risk management. We partner with our health plan clients to provide 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:

1. Performance Metrics and Analytics
2. Content, Records and Data Management
3. IT Organizational Effectiveness
4. 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:

1. Project Governance (e.g., Project Management Office, Model Office Testing)
2. Internal Audit and Audit Committee Advisory
3. Compliance Processes Design and Implementation
4. Enterprise Risk Management (ERM)
5. Model Audit Rule (MAR) Compliance

Operations and Finance: As a health plan’s products and services evolve, so too must the back-office functions that support the business. We offer a wide variety of solutions in areas such as: 

1. Financial Process Optimization, Controls and Integration
2. Revenue Recognition and Reconciliations
3. Spend Analysis and Procurement Streamlining
4. Claims Cycle Effectiveness

Learn about Protiviti's point of view on Construction Risks:
Identifying and Managing Risks on Construction Projects - (PDF) (requires Acrobat Reader; please disable your pop up blocker)