Operations Consulting for Health Plans
Optimize Efficiency, Ensure Compliance, and Strengthen Performance
Our Operations Services Include:
Improve Your Operations
At Rebellis Group, our operations consultants have been in your shoes and bring decades of expertise in helping health plans streamline processes, mitigate compliance risks, and enhance operational efficiency. Whether you're navigating CMS regulations, improving claims processing, or optimizing vendor integrations, our team provides tailored solutions that drive results.
We conduct a comprehensive end-to-end evaluation of your operations, compliance framework, and risk factors, then deliver actionable strategies to ensure seamless execution—whether wanting to rev up existing operations, insource operations from your current vendor or a new program with full health plan implementation. It’s a myth that operating a compliant operations team means no efficiency. Let us validate the best way to maintain compliance with maximum efficiency.
Call Center Assessment & Outsourced Monitoring
Improve call center efficiency, member experience, and compliance.
Enrollment, Premium Billing & Reconciliation
Let us optimize member enrollment, billing accuracy, and financial reconciliation to streamline processes.
Claims and Configuration Review
Check on trouble spots or evaluate the process end to end to improve efficient and appropriate payments. We can also support testing and evaluate claims payment results.
Medicare Secondary Payer (MSP) and Other Health Information (OHI)
We can determine if you have MSP mismatches impacting CMS premium or claims payment results.
IT Infrastructure, Vendor Integrations & CMS/State Reporting
Ensure seamless system integrations, regulatory reporting, and compliance.
Organization Determinations, Appeals and Grievances (ODAG) Case Processing
Improve oversight and accuracy in handling Medicare Part C processing.
Provider/Vendor Contracting & Network Management
Support contracting, network adequacy, and provider/vendor performance oversight.
Interim Staffing
Whether someone is out unexpectedly, or things have gotten busier than expected, let our staff support you.
Why Partner with Rebellis Group?
✔ Deep Industry Expertise – Our team has firsthand experience in health plan operations, compliance, and regulatory processes.
✔ Proven Compliance Strategies – We help organizations meet CMS, state, and industry standards while reducing risk exposure.
✔ Tailored Solutions for Health Plans and vendors – Whether you’re launching a new plan or optimizing existing operations, we provide customized roadmaps for success.