health-plans

Health Plans
Case Studies

Remediation Services

Summary

Our team worked with a health plan to audit current systems in their claims, provider and enrollment areas. Through various assessments across plan operations, we were able to make the plan’s back office run more efficiently.
 

Challenge

  • A medium-sized health plan discovered operational inefficiencies in the areas of claims, provider and enrollment
  • This health plan needed expertise and additional resources to audit the current systems in place that were causing inefficiencies across plan operations
  • Health plan leadership needed a neutral third party with experience to assess and build a roadmap for restoring operational efficiencies while also designing and developing tools for improved decision making

Approach

  • We completed an operational assessment to identify root causes of inefficiencies in the client’s systems, workflows and customer service
  • We validated existing desktop procedures and implemented changes to improve quality and products
  • We completed managed care, provider file, enrollment and claims assessments to pinpoint areas of greatest concern and prioritized areas to target for improvement
  • We compiled a detailed list of system configuration concerns with root causes and deployed a remediation roadmap

Results

  • We reduced the aged claims and adjustment inventory while accelerating claims processing
  • Our team redesigned workflows to maximize operational efficiencies and improve productivity
  • We cleaned up provider file backlog and configuration errors
  • We designed and developed operational dashboard analytics to inform executive decision making and provide an overview of progress