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Purpose-Built ServiceNow Solutions for Healthcare

We work with healthcare organizations to simplify complex workflows, improve team efficiency, and build solutions that actually work using the ServiceNow platform.

Many healthcare teams work around systems that don’t fit the complexity of what they do. Managing claims, prior authorizations, pharmacy issues, and provider data changes often means navigating siloed systems and manual processes. This slows teams down, introduces risk, and creates unnecessary work for people already stretched thin.

esolutionsONE helps healthcare payers, providers, and pharmacy benefit managers build practical, well-designed solutions on the ServiceNow platform. For payer organizations, we deliver workflows for claims exception handling, FWA reviews, benefit design changes, and more. Our team has implemented over 100 ServiceNow projects across industries, including for healthcare clients such as OptumRx, Blue Cross Blue Shield, and Hazelden Betty Ford.

Every solution is tailored to how your team actually works with a focus on clarity, ease of use, and long-term maintainability.

What You Can Count On With esolutionsONE + ServiceNow

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Automate the
Complex

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Scales with Your
Growth

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Designed for
Healthcare Teams

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Informed by
Real Healthcare Work

Solutions We Provide for Healthcare Teams with ServiceNow

Real examples of how our ServiceNow solutions support payers, providers, and healthcare operations.

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Claims Exception Workspace

The challenge:
Manual claims processes lead to 10–20% exceptions and over $10 per claim in added costs. Unstructured data and outdated systems make tracking and audits difficult.

What we deliver:
Automated workflows that cut processing time by 30%, enable real-time tracking, and integrate with existing claims platforms to support audit readiness.

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Fraud, Waste, & Abuse (FWA) Review

The challenge:
Fraud costs healthcare over $100 billion annually. Manual reviews, siloed data, and audit pressure make detection slow and inconsistent.

What we deliver:
A centralized FWA review workspace with a clear, step-by-step process to detect, investigate, and resolve suspicious activity. Structured workflows reduce manual effort, unify data for cross-team collaboration, and support compliance with real-time reporting and audit readiness.

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In addition to claims and FWA, we support a range of healthcare workflows such as prior authorizations, benefit design changes, and provider data updates. We also consider how each solution can support a 360-view of the member, provider, or customer.

As AI capabilities grow, we design with the flexibility to adapt each solution with real people in mind, focusing on what helps them do their work with less stress and more clarity. When systems are built to support people, the work gets better for everyone.

Are you confident in your fraud prevention strategy? Get expert insights to ensure compliance, reduce waste, and streamline investigations.