Payer Solution

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Payers grapple with the continuous increase in healthcare costs, including medical treatments, pharmaceuticals, and administrative expenses, while having to navigate a complex web of healthcare regulations and compliance requirements. Besides, there are challenges of member engagement and retention, provider relationship management, network adequacy, and reimbursement rate negotiation.

To ensure they meet the expectations, payers need to leverage integrated CRM solutions with data analytics and cost prediction models to identify cost drivers, optimize administrative processes, and ensure compliance management at every touchpoint. With holistic provider management solutions, payers can drive operational efficiency, improve member satisfaction, and ultimately thrive in a dynamic healthcare ecosystem.

Areas we add value


Payer organizations can attract new members and partners through data-driven marketing campaigns, personalized engagement strategies, and targeted outreach. Whether it's identifying underserved populations or optimizing marketing spend, we elevate your organization's ability to attract key stakeholders, ensuring your growth is both strategic and sustainable.


With Salesforce as our cornerstone, we streamline payers’ member enrollment processes, simplify credentialing, and enhance the overall acquisition experience using automated application workflows and integration with third-party data sources.


Redefine operational efficiency with a suite of tools and best practices to automate claims processing, optimize provider network management, and facilitate seamless member communications. By customizing Salesforce to your unique needs, we transform administrative challenges into opportunities for cost savings, compliance, and exceptional member service.

Care Management

Our tailored solutions enable real-time care plan updates, automated care team collaboration, and member-centric interventions. With a focus on outcomes and member engagement, our use cases drive improved health outcomes and reduced costs.

Intelligent Insights

We deliver predictive modeling, risk stratification, and advanced reporting capabilities, allowing you to make informed decisions, identify emerging trends, and optimize resource allocation.

360 Degree View

Salesforce enables us to create a comprehensive, 360-degree view of each member, provider, and partner in your payer ecosystem. Through integrated data from various touchpoints, our solutions provide a holistic understanding of relationships, preferences, and interactions, turning raw data into strategic assets.

The Sumeru Difference

Within the current technological landscape, disparate-yet-packaged solutions have become the status quo. These may drive operational efficiencies by expediting claims processing but deteriorate the overall experience for members. Data flows are less harmony and more cacophony thanks to siloed systems and incompatibilities. At Sumeru, we understand to elevate and unify the experience across stakeholder belts, enabling clear data communication flows that make sense for overall business performance.

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