Hemisferica’s approach to dental claims processing and adjudication is simple – we work hand in hand with our partners, utilize a highly skilled group of professional claims adjudicators, a highly competent operations team, project managers and a team of experienced IT professionals to deliver excellent quality service to Healthcare payers. Hemisferica's outsourced solutions will allow clients to generate an average of 25% savings in their dental transaction and claims processing costs.

Our aim is to serve as strategic partners to our clients. Hemisferica is not merely an avenue for Healthcare payers to achieve cost reductions and streamline operations, it also as a facilitator in ways that include allowing our partners to focus resources on their core products and competencies and in freeing up investment capital to invest in growth activities.

We realize the fact that outsourcing could be a very important part of a successful and sustainable business model. It is with this caveat that we encourage our partners to involve outsourcing as part of their business strategy and to leverage off our core competencies to add value to their services and meet the needs of their customers.

CERTIFIED CLAIMS ADJUDICATORS

All Hemisferica’s claims adjudicators are knowledgeable on multiple adjudication platforms and plan designs, specializing in independent platforms and accounts. In order to keep the skills of our adjudicators they go through rotations and cross training programs that allow them to gain specialized know-how on other plan designs and platforms. Our adjudicators are highly trained individuals with knowledge of dental processes, procedures and terminology. Our new adjudicators must undergo concentrated cross functional training programs. The programs are administered by senior dental claims adjudicators with over 15 years industry experience.

CLIENT SPECIFIC TRAINING

In order to ensure the highest quality personalized service, Hemisferica’s dental claims adjudicators go through client specific training to learn the client’s insurance plan designs, policies, systems and claim types. Hemisferica collaborates with the client to develop a precise project plan, analyze the needs of the customer and determine the recommended solutions by identifying the project’s critical success factors. Before the development of the project plan, a project manager is assigned to lead the effort from beginning to end. As part of the process the Hemisferica team with the collaboration of the client, drafts a detailed communication plan in order to identify the most efficient communication channels and points of contact. These points of contacts include our customer support specialists, our help desk staff and our technical staff. One of the details that sets us apart from the competition is our open communication policy.