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The Provider has more than 700,000 members with health, life, and dental coverage. The depth and breadth of care offered means more than one million document pages are received every month including 650,000 multi-page claim documents. Its 2,000 employees are tasked with processing 12,000 claims a day.

Challenges


The Insurer’s employees were dependent on paper-based content and chained to an inefficient system calling for the necessity of low-value manual tasks, which slowed response time to customer inquiries, increased costs and created hassles at every turn. A new administrative system helped improve the situation, but it still had functionality gaps that did not solve all of the client’s challenges. The Insurer selected IPD Solutions as its partner to lead an operational transformation.

Objectives
 
  • Solve 95% of member inquiries on the first contact
  • Meet an average 5-day turnaround time for claims processing Record a 99.5% accuracy in claims payments
Solution


To stay competitive and retain valuable customers, the Insurer implemented a process and content management solution from IPD. IPD’s powerful solution enabled the client to meet its service and productivity goals and provided substantial savings compared to the existing environment.


Efficiencies created by workflow optimization gave the Insurer a competitive advantage over other health insurers. An initial implementation for 500 users focused on the areas of Claims and Customer Service. IPD’s tailored software delivers process automation and control, fast access to information and tightly integrated applications. Now claims are accurately paid within days instead of weeks, and information flows smoothly and quickly across the enterprise.


"I think IPD’s solution offers a lot in the way of multi-tasking. It’s more than just imaging a document or routing a claim from one desk to another. It’s the ability of the system to apply multiple commands when a claim is completed," says the Director of Claims. "When the processor hits thumbs up, a number of things happen that before might have taken ten additional steps."

The Insurer needs the agility to add new users easily and quickly. The agile IPD solution allows for the rapid addition of new users and supports the ongoing addition of new types of work based on configured distribution rules. In addition to IPD’s transformation of claims and customer service, the client selected IPD to implement an enterprise-wide process management solution. Now Enrollment, Accounts Receivable and all incoming documents benefit from IPD’s robust solution. The projected direct cost savings for the project are in the millions of dollars and the benefits to the customer are immeasurable. 

See the U.S. Health Insurance Provider case study.