Solutions

Payer

For Payers, Opus360 offers a wide range of comprehensive, customizable services, including Underwriting, Plan Design, Marketing Support and Network Development.

With Opus360, you’ll enjoy consistently high-quality results, every time.

Underwriting

Hines’ Underwriting, built on continuous analysis and predictive modeling, is designed to embrace your members’ needs while optimizing your costs, through:

  • Support for clients and stop-loss carriers with predictive modeling
  • Analytics showing the impact of Opus 360 on your business and for your members
  • Hines Business Intelligence team provides ongoing analysis, cost modeling and optimization strategies
  • Extensive assistance with analytics with Stop-Loss Carriers during renewals

Plan Design

Hines’ comprehensive, robust and flexible Plan Design services are crafted so your members get the best care, at the right cost:

  • Recommendations on plan language to support Opus 360’s suite of products
  • Consultative support on medical trends, alternatives and regulations
  • Regular reviews of claims experience to deliver a concise summary of opportunities and potential SPD improvements
  • The objective: reducing costs and Population Management through better healthcare utilization, claims management and member engagement

Marketing

When it comes to successful sales campaigns and customer relationships, Hines’ Marketing Support provides you with a strategic and creative advantage, including:

  • Client support during the sale and implementation for your new business opportunities
  • Customized analytical support, member communication, education materials available on demand

Network Development

Because Network Development is key in adding value to competitive contracting, Hines offers:

  • In-house network management and direct provider contracting teams
  • Qualified development of custom EPOs and Narrow Networks
  • Access and utilization of over 110 PPOs and specialized networks including telemedicine, visiting physicians, oncology, transplants, cardiac, etc.
  • Specialized programs for in and out-of-network claims
  • Through our parent company, Global Excel Management Inc., worldwide coverage for any out-of-country assistance and claims