Case Study: Healthcare
A Large Health Payer Organization
A Large Health Payer Organization
Business Process Outsourcing
As a large health payer organization prepared for the impact of a Health Insurance Portability and Accountability Act (HIPAA) deadline, it determined that it wanted to ensure compliance without sacrificing customer satisfaction.
To meet this goal, the organization decided to develop a contingency plan in the event a large influx of paper claims materialized as mandate deadlines hit. Simultaneously, the health payer organization wanted to create flexibility within its claims processing unit to address excessive temporary and overtime costs. Working with Keane Worldzen, the organization is recognizing the benefits of our optimization approach experiencing up to 50% cost savings, improved claims processing accuracy, and timeliness.
Client
One of the nation’s leading administrators of government contracts and recognized as a top employer in its state, this large health payer organization has over a million members and more than 12,000 employees. It provides a comprehensive suite of health insurance and services such as traditional indemnity, dental, vision, and Medicare supplemental coverage, as well as third party administrative services.
Challenge
The client needed to meet the operational requirements for claims processing while simultaneously focusing on meeting a HIPAA deadline.
Additionally, the client wanted to create a "state of future preparedness" for any situation that may arise from the new legislation.
Solution
To help meet its goal, the large health payer organization, working with Keane Worldzen, created a cost-effective contingency plan in the event a large influx of paper claims materialized and cracked the code to achieve the optimal convergence of the highest business performance at the lowest operating costs. Through the combination of Keane Worldzen’s Business Process Outsourcing (BPO) service and global delivery, the client has hit the "sweet spot" by utilizing a solution that delivers increased flexibility, optimized processes, and up to 50% cost savings.
The Keane Worldzen team augmented the organization’s capacity by leveraging Keane Worldzen’s Business Processing Center (BPC) in India as a direct extension of it’s claims processing operations for the healthcare organization. At the BPC, resources are readily available and prepared to handle volume influxes and meet capacity overflow demands. As a result, the health payer organization experiences greater flexibility to meet the ebb and flow of business demand and it is:
• Processing claims faster
• Meeting timeliness and exceeding accuracy goals
• Experiencing quality improvements in the consistency of data
• Increasing its 1st pass auto resolution rate
Working with the large health payer organization, Keane Worldzen developed a customized approach to outsourcing that accounted for the client’s needs, "appetite" for change, and existing technology capabilities and created a flexible and scalable workforce that assists the health payer in contingency planning.
Within two weeks of the decision date to move forward with implementation, Keane Worldzen conducted a "Proof of Execution" where live claims were being processed quickly freeing up in-house staff to focus on more strategic initiatives.
Results
As a result of the relationship between the health payer organization and Keane Worldzen, the client is realizing the following benefits:
• Up to 50% cost saving by reducing cost of operations by almost $1M annually
• Processing more than 1 million claims annually
• Experiencing over 99% claims payment and 98.5% procedural accuracy
• Reduced overtime required to process claims
• Increased flexibility in meeting overflow demands
• Reduced the negative impacts of internal turnover
• Increasing quality
• Enhancing the customer experience/better customer service
Ultimately, Keane’s Business Process Outsourcing service has enabled this large health payer organization to put a contingency plan into effect that improves customer service through its ability to process claims faster and more accurately, while the client remained dedicated to its HIPAA compliance initiative.
About Keane Worldzen
Keane Worldzen is focused on reducing operating costs through its Business Process Strategy, Business Process Improvement, and Business Process Outsourcing Services. While most vendors relocate clients' business processes as a simple cost-cutting measure, Keane Worldzen combines onshore process optimization with offshore outsourcing — helping clients leverage BPO to reduce costs while transforming their operations for sustainable business benefit. For more than 25 years, Keane Worldzen has implemented operations changes for Fortune 500 companies — with particular expertise in the healthcare, insurance, financial services, and debt management industries. Keane Worldzen is the Business ProcessServices arm of Keane, Inc.
For additional information regarding Business Processing Outsourcing services, please contact Rob Himes at Robert.himes@keaneworldzen.com
Keane
|
