Services-146

The Situation:

A health care administration, claims processing, customer support and systems support entity (back office) of a major corporation wanted to improve operational efficiencies of one of their best operated, managed and highest productivity contracts while maintaining and/or improving customer service levels.

The Driver Goals:

• Increase bottom line profits by $2,650,000 by end of year
• Accretive to current fiscal year plan
• Maintain / increase customer satisfaction

• Annualized Benefit Achieved At Call Center- $1,350,000
  • Decreased cost per minute by 18% and headcount from 122 to 105
  • Increased productivity, utilization and effectiveness.
• Annualized Benefit Achieved in Correspondence/Research-$213,000
  • Streamlined processes, enabling progression to a paperless environment
  • Established targets for production and quality.
  • Implemented individual tracking of production to emphasize accountability and responsibility for results
  • Delivered a revised organizational approach, including merging units, combined position descriptions, and skills requirements to better balance resource loads and further reduce costs
• Annualized Productivity Benefit Achieved in Claims Processing- $500,000
  • Productivity improvement of 12.4% (from 127 to 143 Claim Lines per Examiner per Hour) and created four initiatives in appeals process improvements
  • Increased Utilization from 84% to 96%
  • Reset Suspense Processing Production Standards, Implemented improved examiner training program
• Annualized Productivity Benefit Achieved in Conversion From Paper to Electronic Claims -$500,000
  • Achieved 105% of targeted benefit (18% improvement from base)
  • Executed outbound call Campaign to Top Tier Providers.
  • Implemented new processes and tools to expedite, track and ensure Providers who committed to convert to electronic actually did.
  • Utilized Regional Representatives to following-up on campaign commitments via phone calls and site visits.

• Total Benefit: $2,563,000