Claims Workflow Automation

Claims Workflow Automation

Healthcare

THE CHALLENGE.

The client, a healthcare major, wanted to enhance its operations by maximizing the capabilities of its core administration system. The major health insurance company faced a challenge in managing claims workflows: It didn’t have an effective workflow strategy. Claims received had to be manually forwarded to the company’s claims department through its various processing departments. Without either one accountable person or a tracking process in place, the company had difficulty tracking the status of claims, which at times got lost. This impacted service levels, as well as member and provider satisfaction—and resulted in costly fines for late payments. To address these issues, the company implemented our custom workflow application.

Claims Workflow Automation

Healthcare

THE CHALLENGE.

The client, a healthcare major, wanted to enhance its operations by maximizing the capabilities of its core administration system. The major health insurance company faced a challenge in managing claims workflows: It didn’t have an effective workflow strategy. Claims received had to be manually forwarded to the company’s claims department through its various processing departments. Without either one accountable person or a tracking process in place, the company had difficulty tracking the status of claims, which at times got lost. This impacted service levels, as well as member and provider satisfaction—and resulted in costly fines for late payments. To address these issues, the company implemented our custom workflow application.

Google TensorFlow™

APPROACH.

Our Custom Workflow Application helps our client prioritize claims, replacing cumbersome manual reports and spreadsheets with real-time management views. Using the system, claims supervisors can now locate a claim and continuously track its status. In addition, the application’s alert feature notifies senior management when claims are approaching interest and penalty status, so they may be resolved within the 45-day guideline.

RESULTS.

Improved Productivity

20% increase in processing productivity

LESSER PENALTIES

12% decrease in penalty payments 2016 YTD compared to 2017 YTD

VALUE.

Our solution reduces costs, enhances member and provider satisfaction, and improves productivity for the client by automating its claims tracking and workload management processes. In addition, the efficiency gained enables the health plan to absorb analyst attrition without replacing staff.