Catalyst Solutions

What Catalyst Solutions does

Catalyst Solutions is a privately held, US-based business process outsourcing and management firm that operates exclusively in the healthcare payer market. Founded circa 1997 by Rachel Spilo and headquartered in Greenwood Village, Colorado, the company delivers technology-agnostic BPO/BPM, BPaaS, consulting, government program services, and AI-enabled digital solutions to more than 200 health plans across 48 states, completing over 3,500 implementations and supporting approximately 20 million Medicaid and Medicare members on behalf of clients. Its offering spans claims processing, configuration, enrollment, member and provider contact center, provider credentialing, appeals and grievances, billing and finance, and clinical management services, delivered through a hybrid onshore/offshore model with outcome-based, shared-risk commercial structures.

The company's core technology is the proprietary CatalyZe™ BPaaS framework, an adaptive, platform-agnostic orchestration layer that integrates with 30+ leading payer core systems (QNXT, Facets, HealthRules, Amisys, NASCO, Tapestry, TriZetto CareAdvance, NetworX, ZeOmega Jiva, MHK CareProminence, and others) without requiring legacy replacement. AI and digital capabilities are embedded across operations through NLP-powered virtual agents, predictive analytics, anomaly detection for fraud/waste/abuse, autonomous AI agents with human-in-the-loop controls, generative AI for content and workflow automation, and a proprietary Process Discovery AI Agent that converts operational telemetry into an automation roadmap. These capabilities are reinforced by the wholly-owned sister company healthplans.ai, which productizes AI solutions for payers and is led separately by Rachel Spilo following the February 2026 leadership transition.

Catalyst generates revenue primarily through outcome-based managed services contracts (BPO/BPM and BPaaS), supplemented by professional services consulting, AI-as-a-Service subscriptions, and government program engagements spanning Medicare, Medicaid, D-SNP, Commercial, Self-Funded, and Exchange plans. Pricing is custom and not publicly disclosed, structured around multi-year engagements with financially-backed SLAs. Distribution combines direct enterprise field sales with channel partnerships (TriZetto Consulting Partner Network, ACAP Preferred Partner) targeting health plans ranging from startup plans to the largest national payers.

Name

Catalyst Solutions

Legal name

Catalyst Solutions

Website

https://catalystsolutions.com

Company type

Private

Founded year

1997

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Catalyst Solutions is a US-based, payer-exclusive BPO/BPM and BPaaS provider delivering technology-agnostic operations, consulting, and AI-enabled services to 200+ health plans across 48 states. Its CatalyZe™ platform integrates with 30+ payer core systems, supported by AI subsidiary healthplans.ai.

Ownership category

akta.pro rank

Product category

Healthcare Payer BPO/BPM and BPaaS Services

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Computer Systems Design and Related Services (54151)

SIC

Services-Computer Programming, Data Processing, Etc. (7370), Services-Computer Programming Services (7371)

akta.pro industry

PRIMARYBPAAAFAA

Insurance Claims Intake & FNOL Support

Business & Public Services/Administrative & Support Services (BPO, Call Centers, Back Office)/Claims Processing & Adjudication Support

SECONDARYHDAEANAE

Enterprise AI Governance, Risk & Compliance Platforms (Model Risk, Audit, Policies)

Hardware, Technology & Telecom/Enterprise Platforms & Databases/Artificial Intelligence Platforms for Enterprise

Keywords

• Healthcare payer BPO
• BPaaS platform services
• Claims operations outsourcing
• Health plan consulting
• AI-enabled payer solutions

Headquarters

HQ city

Greenwood Village

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. BPO/BPM Services: Outcome-driven business process outsourcing and management services that replace variable internal costs with performance-backed service delivery. Delivered onshore, offshore, or hybrid.
2. BPaaS (Business Process as a Service): Integrated platform and operational expertise delivered under shared-risk models through the CatalyZe™ framework.
3. Consulting Services: Outcomes-based consulting services to improve core operations, modernize systems and processes, and execute change. Includes strategic advisory, system assessments, implementation support, and regulatory change readiness.
4. AI & Digital Services: AI adoption guidance, AI as a service, and digital optimization embedded across operations to streamline work, enhance decisions, and drive efficiency.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

Catalyst Solutions delivers AI-enabled BPO/BPM, BPaaS, consulting, and AI/Digital services exclusively to U.S. healthcare payers (health plans), operating across Medicare, Medicaid, Commercial, D-SNP, and Exchange lines of business. Its core offering bundles outcome-based managed services — claims processing, enrollment, configuration, contact center, provider credentialing, and analytics — with the proprietary CatalyZe™ BPaaS framework and AI engineering (AI as a Service, Process Discovery AI Agent) delivered under shared-risk SLAs.

Product overview

Catalyst Solutions offers a comprehensive portfolio of healthcare payer-focused services built around a unified platform-plus-services architecture. The core offering combines AI-enabled BPO/BPM services with the proprietary CatalyZe™ BPaaS platform—an adaptive, cloud-ready orchestration framework that modernizes workflows without replacing legacy systems. The portfolio includes consulting services (strategic advisory, system modernization, regulatory change readiness), AI & Digital Services (AI as a Service, AI Adoption, Digital Optimization), and Government Services. The AI as a Service offering provides end-to-end AI agent development and management, while AI Adoption Services guide organizations through enterprise AI transformation. All offerings are powered by healthplans.ai technology and leverage nearly 30 years of payer-exclusive operational expertise across 200+ health plans in 48 states.

Differentiator

Problem solved

Functional benefit

Brands

• CatalyZe™: AI-enabled, BPaaS (Business Process as a Service) platform and framework for payers that provides adaptive process orchestration without replacing legacy systems

Products and services

• Payer BPO/BPM Services AI-enabled business process outsourcing and management services for healthcare payers, covering claims processing, configuration, eligibility and enrollment, encounters, fulfillment, member and provider contact center, provider credentialing, fraud waste and abuse, help desk, analytics and reporting, appeals and grievances, and billing and finance. Delivered outcome-driven under shared-risk SLAs onshore, offshore, or hybrid.

Quantifiable outcome

• Serving 200+ health plans across 48 states with 3,500+ implementations completed
• +3 more outcomes

Named customers3 records

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability9 records

Feature6 records

Partnerships

Five partnerships are on record, tiered strategic, preferred partner, core and case study.

• P3 Health PartnersstrategicStrategic or Co-development Partner · 1 May 2025Professional Health Partners Services (P3) implementation launched across Arizona, Oregon, Nevada, and California. Catalyst supports configurations, claims, and provider call center operations for 11 active health plans serving nearly 68,000 Medicare members. Completed in 60-day timeframe.
• ACAP (Association for Community Affiliated Plans)preferred partnerGTM or Marketing Partner · 26 November 2024Catalyst is a Preferred Partner of ACAP, presenting webinars on health plan member and provider engagement, innovative cost reductions, and AI use cases for ACAP member health plans.
• TriZetto (Cognizant)coreChannel Partner/ Reseller/ Distributor · 13 June 2022Catalyst joined the TriZetto Consulting Partner Network, gaining access to APIs, utilities and software for Facets, QNXT, CareAdvance and NetworX. Authorized to support TriZetto clients with upgrades, reports, custom extracts, custom code development, configuration and testing. Catalyst can support TriZetto's ancillary products including Workflow, Elements, TranZform, TruProvider, ClaimSphere, and others.
• healthplans.aicoreStrategic or Co-development Partnerhealthplans.ai is a Catalyst-incubated sister company that leverages Catalyst's decades of payer expertise to build smarter, AI-enabled solutions for payers. It reflects how health plans actually work with solutions designed with regulatory, operational, and financial constraints in mind. Powers Catalyst's AI services with faster path from concept to deployment.
• Delta Dental of Coloradocase studyStrategic or Co-development PartnerCatalyst partnered with Delta Dental of Colorado to transform claims and workforce performance. Engagement included Targeted Solution Session, claims operations support, Process Discovery AI Agent deployment, and workforce management analysis.

Scale indicators6 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• Cognizant (TriZetto): Cognizant owns TriZetto, the dominant payer core platform vendor that Catalyst partners with through the TriZetto Consulting Partner Network. Cognizant competes directly with Catalyst for payer BPO/BPM, implementation, and consulting work on Facets, QNXT, and NetworX, while also being Catalyst's channel partner — making it the most directly comparable peer.
• NTT DATA: NTT DATA is a leading consulting and systems integrator for healthcare payers, with deep TriZetto platform expertise and a strong payer BPO practice. It competes head-to-head with Catalyst on QNXT/Facets implementations, payer modernization, and managed services for the same health plan clients.
• Genpact: Genpact is a major global BPO and digital transformation provider with a sizable healthcare and payer practice covering claims operations, member/provider services, and AI-enabled process automation. Catalyst's BPO Operations Leader Nishant Mishra previously held leadership roles at Genpact, underscoring direct operational overlap and talent competition.
• Firstsource Solutions: Firstsource is a pure-play BPO with a strong US healthcare payer vertical, delivering claims processing, member engagement, provider data management, and analytics to health plans. Its target customers and service portfolio substantially overlap with Catalyst's payer BPO/BPM offerings.
• Conduent: Conduent is a large business process services company with significant healthcare payer and government health exposure, including claims administration, contact center, and member services. It competes directly with Catalyst on payer and Medicaid/Medicare BPO engagements.
• Hinduja Global Solutions (HGS): HGS is a global BPO with a substantial US healthcare payer practice covering member services, claims, and care management. It uses a similar hybrid onshore/offshore delivery model and competes for the same mid-market and enterprise payer work as Catalyst.
• Gainwell Technologies: Gainwell is a major government healthcare services provider focused on Medicaid and public health programs, directly overlapping with Catalyst's Government Services and Medicaid Modernization practice. Multiple Catalyst executives (including CEO Sas Mukherjee and CDIO Aneesh Kumar) are Gainwell alumni, making it a close operational and competitive peer.

Broad incumbents

• Accenture: Accenture operates one of the largest healthcare consulting and BPO practices globally, serving payers across strategy, implementation, and managed services. It is a broader incumbent rather than a payer-exclusive specialist, but routinely competes with Catalyst for large payer transformation and outsourcing engagements.
• Wipro: Wipro is a global IT and BPO services firm with a sizeable US healthcare practice spanning payer consulting, claims BPO, and AI-enabled operations. It competes with Catalyst as a broader incumbent with significantly greater scale and offshore delivery capacity.
• Infosys: Infosys is a global IT services and BPM provider with established healthcare payer and provider practices, including claims, member services, and digital transformation. It is a broader incumbent than Catalyst but competes in the same payer BPO/consulting opportunities, particularly on platform implementations and managed services.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/catalyst-solutions-llc
• Xx.com/CatalystSolutio
• Facebookfacebook.com/CatalystSolutions99

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles13 records

Subsidiaries1 record

Funding overview

Funding rounds

Investors

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

M&A8 records

Investments

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

Frequently asked questions about Catalyst Solutions