We’re betting big on tech to improve customer experience: Carelon's Rajat Puri

US-based Carelon Global Solutions, a healthcare services company formerly known as Legato Health Technologies, is growing at a scorching pace and transforming itself as a differentiated healthcare platform and is betting big on artificial intelligence (AI) to improve customer experience and grow its business.

Since beginning operations in India in 2017 as a Global Capability Center (GCC), the company has expanded to employ over 18,000 people in Hyderabad, Gurugram, and Bengaluru, and a total of 25,000 across five countries, including the US, Ireland, Puerto Rico, and the Philippines.

In an exclusive interview with TechCircle, Chief Operating Officer (COO) and President Rajat Puri discussed the company’s AI initiatives and future plans, emphasising the importance of consumer experience in the dynamic healthcare landscape.

According to Puri, by leveraging AI, Carelon has enhanced administrative efficiency, optimised talent productivity, and improved the health insurance consumer experience.

“For example, to help contact centre executives offer quick and personalised solutions to members, we built a speech-to-text transcription and analysis platform that helps them document highlights of the call and recommend solutions,” he said.

This, according to Puri has significantly reduced the time taken to complete a call allowing them to focus on critical work and helping payers to track grievances/feedback. Our voice assistant also empowers members to make informed decisions with instant access to healthcare information and wellness insights.

Furthermore, Carelon employs natural language processing (NLP) and robotic process automation (RPA) to automate manual tasks and streamline workflows, enhancing precision in claims processing including enrolment, underwriting, billing and more.

Puri noted, “By automating appropriate transactions, we enable insurers to be more efficient in claims settlement and reduce operational costs.”

On the company’s growth plans, Puri said, with a vision to become an exemplar GCC, we will continue to expand our capabilities and pursue collaborative partnerships with startups that will help us strengthen our expertise in commercialisation and evolve our role as a managed services partner.

The US health solutions firm is also betting big on the Indian talent. The company puts its people at the centre of everything it does, with a transparent and open culture that values input from associates, said Puri, adding that in the next one year, the company is actively recruiting and hiring for roles in information technology, business operations, data management, analytics, digital, and AI.
“We believe that a secure data-led infrastructure can propel healthcare beyond traditional bounds and potentially improve health equity. With the help of the collective capabilities, we have built-in Carelon, we are working on enabling connected care and advancing whole health,” he said.

The India centre plays a crucial role in advancing data analytics and IT innovations for the global organisation, with a diverse team of healthcare experts, including data scientists, claims specialists, and medical professionals, collaborating to enhance healthcare operations. Carelon has the capacity to develop technologies across various domains, such as FACETS, Pega, Java, SQL, Salesforce, and business process as a service (BPaaS).

India will remain Carelon’s innovation hub, having initiated work on a customer-centric platform early in its GCC journey. This platform, which includes an app, allows users to access their medical history, insurance plans, claims status, ID verifications, and appointment information. Users can also utilise virtual healthcare services, including conversational AI and virtual care. The India team collaborated with the US team to develop and manage the app, enabling associates to focus on higher-value, consumer-centred activities.

The GCCS in India's healthcare sector has experienced remarkable expansion in recent years, particularly following the Covid-19 pandemic. As of 2024, NASSCOM estimates the country is home to more than 1,700 GCCs, with over 400 of these centres established since 2019.

According to the consulting firm Zinnov, approximately 80 of these GCCs are integrated within the healthcare ecosystem. Notable participants in this field include Optum, United Health, Elevance Health, and Thryve Digital. Currently, over 250,000 individuals are employed within India's healthcare and life sciences GCCs, with a significant concentration of these centres located in Delhi-NCR, Bengaluru, Hyderabad, and Mumbai.