Appeals & Grievances 

Simplify Appeals & Grievances processes with tailored solutions to satisfy compliance regulations 

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When complex, knowledge-based operations rely on manual, paper-based processes, the results are low productivity and a diminishing bottom line 

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Encora’s solutions helptransform operations, leading to

Greater agility

Reduced costs

Higher productivity

Increased revenues

Improved customer satisfaction and retention

Faster, smarter investigations and resolutions

Encora’s Tailored Appeals & Grievances Solutions: 


Promote rapid member access to care and claim payments


Confidently comply with contractual and regulatory obligations


Drive compliance with state, federal, NCQA, and group guidelines


Track completed and outstanding cases with comprehensive audit trails


Automatically print the case file for legal discovery or regulatory requests


Increase productivity and decision-making as all the relevant information is consolidated into a single view


Automatically distribute and prioritize each new complaint or appeal. Capture, catalog, and store all case-related information and documents


Automatically match requested information responses for pending cases to the right case file, reactivate the case and notify personnel of the updated status