Healthcare payers are not just under pressure. They are expected to transform in real time. Between evolving regulations, rising consumer expectations, digital demands, and cost containment goals, the stakes have never been higher.

We partner with national and regional payer organizations to drive transformation across operations, claims, care management, provider relations, digital initiatives, and enterprise functions. Our focus is execution, helping health plans move critical work forward when strategic priorities outpace internal capacity.

Built for payer environments

Our model is designed for the realities of payer organizations. It adapts to shifting regulations and benefit designs, scales across business lines and geographies, and reflects the operational and compliance demands health plans navigate every day.

Whether the challenge is improving operational efficiency, modernizing member engagement, advancing value-based care, or supporting large-scale transformation efforts, we bring the structure and expertise needed to keep initiatives moving.
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Execution over advice

We do not show up with binders. We show up with a plan, the urgency to move, and the right blend of project management precision and change management expertise.

When strategic initiatives outpace internal bandwidth, health plans partner with us to embed cross-functional experts directly into their teams. That execution spans operations, claims, care management, provider relations, digital transformation, and enterprise functions.
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The right resources for the work

Every engagement is anchored by proven consultants with 10 to 20 years of experience leading large-scale payer transformation programs.

The shape of the resource matches the shape of the problem:

Project or team leadership when you need someone to run the program
Full project teams when you need end-to-end delivery
Subject matter experts when you need domain depth
Operations and project support when you need surge capacity

What we deliver
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Program implementation

Management of large cross-functional implementations, including scope definition, customer requirements, milestone tracking, and risk management through delivery to market.

Payer operational transformation

Strategies that optimize and streamline operations to improve quality, efficiency, and visibility across service operations.

Value-based care

Shared risk model design, incentive program development, partnership program build-out, and outcome and cost modeling.

Claims processing optimization

Process optimization and automation opportunities, technology review and implementation, and enhancement of self-service tools and portals.

Payment optimization

Streamlined payment integration and increased electronic adoption to reduce leakage and improve provider satisfaction.

Price transparency

Payer contract negotiation strategy, consumer-friendly compliance execution, and development or update of member-facing marketing material.

New product innovation

Identification of market segment needs, competitive differentiators, and go-to-market strategies that target customers, increase speed to market, and fuel growth.

Behavioral and physical health product development

Product design that improves access to care and utilization of behavioral health services within the payer's benefit structure.

Digital innovation and transformation

Human-centered strategy and design that identifies required digital capabilities and streamlines or automates existing processes across the member, provider, and enterprise experience.

Call center modernization

Modernization of call center ecosystems to give agents the skills, tools, and data they need to support members' needs.

Governance, risk and compliance

ERM, ESG, HIPAA, cybersecurity, and price transparency programs, with governance structures that drive accountability across the organization.

Grievance and appeals workflow solutions

Workflow tools to manage, track, and report on the grievance and appeals process.

Why ZRG

Built for payer environments, not adapted to them.
Our operating model is designed for the specific complexity of health plan operations: — shifting regulations, benefit design variability, and compliance-heavy workflows across business lines and geographies.

Consultants with 10 to 20 years of payer transformation experience.
Every engagement is led by proven operators who have run these programs before. You are not paying generalists to learn the industry on your dime.

Flexible talent structure that matches how the work actually shows up.
Project or team leadership, full project teams, subject matter experts, or operations and project support. Same team, four ways to engage.

Full project delivery, not just advice.
We deliver end-to-end, from business requirements analysis through change management. When execution stalls, we are the team that finishes the work.

Trusted by the payer market that matters. Strategically partnered with 100% of the top 10 North America payers, 100% of Fortune 500 payers, and 100% of Fortune 50 healthcare companies. That base gives us pattern recognition across the initiatives you are running now.

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Proof in the work

Forecasting and cost allocation model design
ZRG partnered with a large multi-state health plan to recover revenue lost to inaccurate cost-sharing calculations. Our team designed defensible, data-backed cost allocation models spanning more than 40 departments, enabling accurate billing to state government partners. Result: Audit-ready financial models that helped the client substantiate claims, improve transparency, and recapture previously unrecognized revenue.

Indirect cost forecasting transformation
A major health insurer lacked a clear methodology to forecast and analyze nearly $1B in indirect cost allocations. We assessed allocation drivers, chart of accounts, and segment reporting alignment between FP&A and accounting. Result: A flexible, driver-based forecasting model that enabled proactive cost modeling, improved collaboration, and simplified allocation across market segments.

Treasury and investment optimization
ZRG advised a national payer on treasury and investment strategy as part of a broader cost and performance transformation. The work included transition to an outsourced CIO model, development of 13-week cash flow forecasting, redesign of treasury reporting, and support for retirement plan governance. Result: Real-time visibility into cash performance and an investment strategy aligned with enterprise goals.

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