Overview:

Process Redesign and Change Management to define a flexible, scalable workforce for an East Coast Healthcare Payer.

Business Issue:

This client needed to prepare for a potential increase in the volume of paper claims received as a result of HIPAA while maintaining compliance with service level agreements and simultaneously addressing excessive temporary and overtime costs.

Actions:

• Developed a customized approach to outsourcing that accounted for client’s needs, capacity for change, and technology capabilities
• Led and managed the rapid “Proof of Execution” pilot, where claims processing began within 2 weeks, providing immediate benefit and freeing up in-house staff to focus on complex cases

Results:

• Reduced the need to pay overtime to process claims
• Implemented the client’s first-ever international outsourcing effort, creating a flexible, scalable workforce to assist in contingency planning
• Monitored the ongoing delivery to ensure SLAs were being met when processing more than 1 million claims annually, with over 99% Claims Payment and 98.5% Procedural Accuracy