Healthcare Adminstration

Issue

A major corporation wanted to improve the operational efficiencies of one of its best operated and managed and most productive contracts, while maintaining and/or improving customer service levels within its Healthcare Administration, Claims Processing, Customer Support and Systems Support entity.

Highland Approach

The Highland Group conducted a Discovery and Design process that identified and detailed key issues, including opportunities to streamline processes, restructure and define roles and responsibilities, and improve training.

Actions Taken

• 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 structure, including merging units, combined position descriptions and skills requirements to better balance resource loads and further reduce costs.
• Reset suspense processing production standards and implemented an improved examiner training program.
• Executed an outbound call campaign to top-tier providers.
• Implemented new processes and tools to expedite, track and ensure providers who committed to convert to electronic processing actually did so.
• Utilized regional representatives to follow up on campaign commitments via phone calls and site visits.
• Increased claims processing productivity by 12.4% (from 127 to 143 claim lines per examiner per hour).
• Increased utilization from 84% to 96%.
• Achieved 105% of targeted benefit (an 18% improvement from the base).