Convey Health Solutions

What Convey Health Solutions does

Convey Health Solutions is a healthcare technology and services company founded in 2001 (originally as NationsHealth, Inc.) that provides end-to-end member enrollment, administration, service, and wellness solutions for Medicare Advantage, Part D, Employer Group Waiver Plans (EGWP), Medicaid, and Health Insurance Exchange payers and PBM clients. The company states it supports approximately 19% of Medicare lives through its technology and services.

Its core technology is the Miramar platform, a modular suite covering the full Medicare member lifecycle. The platform comprises Miramar:Member (enrollment, eligibility, and billing), Miramar:Agent (agent onboarding, oversight, licensing, and commissions), Miramar:Benefits (supplemental benefits administration including OTC and flex card programs), Miramar:Reveal (payment reconciliation with CMS and HHS data exchange), and Miramar:Connect (member services interface with CTI integration and RPA-driven guided workflows). Supporting the platform are two key subsidiaries: Pareto Intelligence (healthcare analytics, risk adjustment, RevenueIQ premium integrity, StarIQ Star Ratings analytics) and HealthSmart International (health and wellness product fulfillment acquired in 2022 for $77.5 million). The company holds HITRUST, HIPAA, PCI-DSS, and FedRAMP Moderate certifications, with deep integrations into CMS, HHS, PBMs, claims processors, financial institutions, and the Mastercard network for flex card programs.

Convey generates revenue through a B2B platform-plus-services model sold to health plans and PBMs, combining software licensing and SaaS-style fees from the Miramar modular platform with services revenue from contact center operations, document processing, grievance management, and benefit fulfillment. The company completed a $200 million IPO in 2021 following TPG Capital's 2019 take-private, and has executed multiple acquisitions (Gorman Health Group in 2017, HealthScape Advisors and Pareto Intelligence in 2018, HealthSmart International in 2022) and one divestiture (HealthScape Advisors to Chartis in 2024) to refine its portfolio. In 2026, Convey appointed Michael DiSimone as CEO, launched StarIQ and the Sagility Synchrony strategic alliance, and was named a USA TODAY Top Workplace.

Name

Convey Health Solutions

Legal name

Convey Health Solutions

Website

https://conveyhealthsolutions.com

Company type

Public

Founded year

2001

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Convey Health Solutions provides Medicare-focused technology and services, including enrollment, billing, supplemental benefits, and analytics, to health plans and PBMs. Its Miramar platform and Pareto Intelligence subsidiary serve approximately 19% of Medicare lives across MA, Part D, EGWP, Medicaid, and Exchange markets.

Ownership category

akta.pro rank

Product category

Healthcare Administration Software

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Financial Transactions Processing, Reserve, and Clearinghouse Activities (522320)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing) (FSAIAGAI)

akta.pro secondary industries

Medicare Plan Distribution & Brokerage (Captive, Independent, FMOs) (FSAIAGAH), Medigap Plan Administration (Enrollment, Billing & Member Services) (HLAEADAC), Patient Financial Engagement (Estimates, Billing Presentment, Payments) (HLACAEAI), Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)

Keywords

• Medicare administration software
• Health plan enrollment
• Supplemental benefits management
• Healthcare analytics platforms
• Medicare compliance solutions

Headquarters

HQ city

Sunrise

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Operations, Infrastructure, Marketing or Sales, Supply Chain

Core offering

Convey Health Solutions provides technology, analytics, and advisory solutions for government-sponsored healthcare payers. Its core Miramar platform automates Medicare Advantage, Part D, and Exchange enrollment, billing, member management, and supplemental benefits administration. The company also delivers risk adjustment analytics through Pareto Intelligence and supplemental benefit fulfillment through HealthSmart, serving approximately 19% of Medicare lives.

Product overview

Convey Health Solutions offers a platform-plus-modules architecture centered on the Miramar technology platform for Medicare Advantage and Part D administration. The core Miramar platform provides enrollment, billing, and member management capabilities, with specialized modules including Miramar:Member (core enrollment/billing), Miramar:Agent (agent management), Miramar:Benefits (supplemental benefits), Miramar:Connect (member services), and Miramar:Reveal (reconciliation). Supporting the platform are two acquired brands: Pareto Intelligence (analytics, risk adjustment, RevenueIQ premium accuracy, and StarIQ star ratings) and HealthSmart (health and wellness product fulfillment). Additional modules include OMT (compliance monitoring), OTC benefit administration, flex card programs, document processing, and grievance management. The company serves Medicare Advantage (MA/MAPD), Prescription Drug Plans (PDP), Employer Group Waiver Plans (EGWP), Medicaid, and Health Insurance Exchange markets with technology, analytics, and operational services.

Differentiator

Problem solved

Functional benefit

Brands

• Miramar: Purpose-built technology platform for Medicare enrollment, billing, and member management supporting the entire member lifecycle
• Miramar:Member
• Miramar:Agent
• Miramar:Benefits
• Miramar:Reveal
• Miramar:Connect
• Pareto Intelligence
• HealthSmart
• OMT (Online Monitoring Tool)
• Pareto RevenueIQ
• StarIQ

Products and services

• Miramar Platform Purpose-built technology platform for Medicare enrollment, billing, and member management supporting the entire member lifecycle for government-sponsored healthcare payers.
• Miramar:Agent Medicare agent and broker management solution centralizing onboarding, oversight, licensing validation, certification tracking, commissions management, and sales performance monitoring for health plans.
• Miramar:Benefits Supplemental benefits administration platform supporting OTC, flex card, dental, vision, hearing, transportation, and other supplemental benefit programs with configurable business rules for Medicare Advantage plans.
• Miramar:Reveal Standalone reconciliation technology for Medicare membership and Exchange financial data, managing enrollment and payment reconciliation with CMS and HHS data exchange processes since 2007.
• Miramar:Connect Member services interface with CTI integration and RPA tools empowering contact center agents with aggregated member data, automated alerts, and guided workflows for one-call resolution.
• Pareto Intelligence Healthcare analytics and technology subsidiary providing data management, risk adjustment, and premium integrity solutions for value-based outcomes for risk-bearing payers and providers.
• Pareto RevenueIQ Premium accuracy solution that identifies and recovers mistaken capitated premium payments and mitigates compliance risk by scrutinizing Medicare Secondary Payer validation and End-Stage Renal Disease status.
• StarIQ Analytics platform launched in 2026 providing enhanced intelligence for Medicare Advantage Star Ratings analysis and quality improvement strategies.
• OMT (Online Monitoring Tool) Web-based healthcare compliance solution for tracking, validating, and reporting on required communications and processes used by Medicare payers for audit preparation and ongoing compliance monitoring.
• OTC Benefit Administration Integrated over-the-counter benefit administration program providing benefit cards, home delivery catalog, and clinical program alignment; market-leading supplemental OTC benefit administration since 2008.
• Flex Card Program Medicare flex card implementation and management supporting multiple supplemental benefit types on a single card, configurable with merchant and item restrictions, white-labeled for health plans.
• HealthSmart Health and wellness product fulfillment subsidiary serving retail, hospital, long-term care, schools, and consumer markets with products for healthy and independent lifestyles, acquired in 2022.
• Document Processing & Mail Management Inbound mail and document capture services including paper enrollment forms, COB processing, returned mail handling, and outbound fulfillment with automated triggering and compliance support.

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

AI capability6 records

Recent moves11 records

Expansion highlights6 records

Direct peers

• Inovalon: Inovalon provides cloud-based analytics and SaaS for risk adjustment, quality (Stars), and clinical outcomes data for payers. It overlaps directly with Convey's Pareto Intelligence risk-adjustment and StarIQ analytics offerings.
• Softheon: Softheon provides cloud-based enrollment, billing, and member-management technology for ACA Exchange, Medicare, and Medicaid plans. It directly competes with Convey's Exchange and Medicare enrollment and billing modules.
• Edifecs: Edifecs offers healthcare data interoperability, payer-provider connectivity, and compliance solutions used by Medicare and commercial payers. It overlaps with Convey's Miramar:Reveal reconciliation, CMS/HHS integration, and OMT compliance modules.
• hCentive (Hinduja Group): hCentive delivers broker/agent management, enrollment, and member-engagement solutions to Medicare and commercial payers. It is comparable to Convey's Miramar:Agent and Miramar:Member modules.
• HealthEdge Software: HealthEdge provides a payer-platform suite (HealthRules Payer) for core administration, including enrollment, billing, and claims for government and commercial health plans. It is the closest direct competitor to Convey's Miramar platform in Medicare Advantage administration.

Broad incumbents

• Optum (UnitedHealth Group): Optum operates one of the largest payer-services and health-IT platforms, including risk-adjustment analytics, member engagement, and care management. It is the most consequential broad incumbent competing for Medicare Advantage payer tech spend.
• Cognizant (Healthcare): Cognizant's Healthcare segment delivers IT services, BPO, and platform implementation for payers including Medicare administration. As a global incumbent, it competes with Convey for outsourced payer-services contracts at much larger scale.
• Maximus: Maximus operates large-scale government healthcare contact centers, enrollment services, and BPO for Medicare and Medicaid programs. It competes with Convey for outsourced member-services and enrollment contracts.
• HMS Holdings (Gainwell Technologies): HMS (now part of Gainwell) delivers coordination-of-benefits, eligibility, and payment-integrity solutions for Medicare and Medicaid programs. It overlaps with Convey's Miramar:Reveal reconciliation and RevenueIQ premium-integrity products.
• Infosys (Healthcare / Medicare practice): Infosys provides IT services and platform implementation for Medicare and commercial payers, including enrollment, billing, and compliance BPO. It is a broad incumbent alternative to Convey's platform-plus-services model.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xx.com/ConveyHealth
• YouTubeyoutube.com/user/ConveyHealth
• Facebookfacebook.com/conveyhealthsolutions
• LinkedInlinkedin.com/company/convey-health-solutions

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles10 records

Subsidiaries4 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A4 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Convey Health Solutions