Healthcare Payer


Healthcare Payers face many challenges in the healthcare industry, from expanding regulations to improving the member and provider experience. Kiriworks is focused on assisting payers with the challenges they face in operations, compliance, customer service and IT. Our information management platform helps drive accelerated performance and innovation to meet the demands of this dynamic industry.


Appeals & Grievances

Kiriworks A&G manages every aspect of the appeals and grievances process. From Medicare, Medicaid and commercial plans - Kiriworks A&G has been designed with compliance at the center of the solution. Kiriworks A&G starts managing and monitoring the process the second an appeal, grievance, compliant or inquiry is received. From automated correspondence creation, IRE packet generation, CDAG & ODAG Universe reporting, Data Validation reporting and real-time process dashboards - Kiriworks A&G has you covered.

Claims Integration

Kiriworks Claims Integration extends the value of your core administration platform from vendors like TriZetto and HealthEdge by serving users critical content directly from the applications they use every day. Our code-less, synthetic API facilitates integration with any application in the the matter of minutes. This enables users to access content related to members and providers without leaving their familiar user interface. Beyond accessing content like claims forms, correspondence or medical records - Kiriworks Claims Integration provides users the ability to create correspondence and forms directly from their core application.

Provider Management Platform

The Kiriworks Provider Management Platform (PMP) provides health plans the ability to meet the growing demands of their provider network. From Network Operations to Field Network, the Kiriworks PMP helps health plans address needs from credentialing, contracting, provider outreach and beyond. Each solution within the Kiriworks PMP focuses on providing a holistic view of the provider interactions with the goal of delivering the best provider experience. Whether it is automating the contracting and credentialing processes, delivering dynamic surveys to providers or enabling field workers with a complete mobile experience - Kiriworks PMP will make an impact on your network.

New Business

Kiriworks New Business provides health plans the ability to automate the capture of applications from the point of receipt, regardless of file format or point of origin. Kiriworks Mobile Enrollment leverages the electronic data capture capabilities of our information platform and the mobility of a tablet to create a paperless, efficient enrollment process. Beyond application capture, Kiriworks New Business enables health plans to monitor required information and improve the quality and timing of the new business process. Automatic notifications can be generated and sent to sales agents when items are missing or do not pass the validation requirements. Kiriworks New Business provides transparency across the entire new business life cycle.

Healthcare Payer Impact

The Appeals & Grievance solution designed by Kiriworks is one of the most innovative and configurable solution I’ve encountered. It has the ability to process any line of business and when calculating the ROI on this product, it is easy to see how the cross company usages of this product reveal it pays for itself in no time.

Director of Appeals & Grievances, Gateway Health


Request a Free Demo

We know that reading about enterprise information management and it's benefits doesn't always give a clear picture of how it can help your business. Drop us a request and we'll chat about your business and demo the software capabilities - specific to how they can impact your goals and challenges.

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