Overview:

Process Redesign and Technology Enablement for a paperless enrollment and underwriting workflow for a Large, East Coast Healthcare Payer

Business Issue:

With Healthcare reform resulting in an increasing number, type, and complexity of Individual and Family applications received, this Payer wanted to redesign their individual enrollment process to realize process efficiencies and improve customer and agent satisfaction.

Actions:

• Implemented “Proof of Concept” pilot, creating a paperless enrollment and underwriting workflow and case management process using off-the-shelf Microsoft Operating System and Office Products

Results:

• Identified technology improvements eliminating the need to key family application information into multiple systems
• Improved agent and customer relations by increasing the number of touch points in the process and improving the accuracy of application status information provided
• Decreased maximum process times up to 50% for evaluating and underwriting an application
• Developed and implemented a “triage” approach to underwriting resulting in 42% of applications completing the evaluation process within 2 days of receipt