Healthcare & Life Science

Automated Claim Settlement Cuts Down Processing Time in Half

 

Success Story 

The client was experiencing the effects of their non-optimal ASO (Administrative Services Only) claim settlement operations and identified the need for an automated system that would speed up the process, minimize errors and reduce costs. Scalefocus applied a phased approach that began with defining the pain points and their impact on the client’s business. Our experts then built a fully cloud-based Claim Settlement System that eliminated the extraction of data into excel spreadsheets, automated and streamlined processes and achieved cost optimization while reducing errors caused by manual work.

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Reduced invoice to
payment cycle time

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Improved customer
engagement value stream

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Transparency at all
levels of Claim Settlement

The Client

Our client is a leading US health insurance provider of best-in-class comprehensive coverage. The company’s personalized approach to healthcare made them into a pioneer in the field due to its firm focus on the needs of the communities where their members live. The company works in partnership with doctors and hospitals nationwide and also provides a range of healthcare solutions for people who travel internationally. Their efforts to deliver smarter and affordable healthcare services have turned the client into an innovator who advances secure and stable services for millions of people, leading to improved health results and a better quality of life.

The Solution

The client was using a third party to process their Administrative Services Only (ASO) business. As the invoicing processes for services rendered grew in scope and complexity it became evident that scaling repetitive processes using human resources was cost-ineffective and time-consuming. Some of the steps took up to 7 hours to extract, load and aggregate the data required for invoicing. The dependency of the ASO billing operation on several ad-hoc tools, spreadsheets and manual steps indicated a missing operational IT system in the enterprise application portfolio. The client identified the situation as unsustainable and expressed the need for automated invoicing processes.



The challenges the client faced included:


  • High operational cost to support the current invoicing process

  • Slower than desired time to market of new products and services

  • Limited effective growth of business and inability to service customers optimally

  • Difficulty in managing products and services: lack of common language, rules and policies

  • Lack of tools to support roles and responsibilities for invoicing, finance and customer service operations

  • Risk management hampered by lack of controls and informality of information contained in the spreadsheets and access databases



Scalefocus was brought on board to stabilize and improve the maturity of the ASO billing operation by implementing a new operational solution architected in Microsoft Azure. The goal was to end the reliance on manual imports of claims into excel spreadsheets, provide full transparency and eliminate the time-consuming and error-prone nature of the process. After doing thorough research across the organization our team concluded that the new solution had to be flexible, scalable and secure to support the ASO invoicing and payment management operation. To fully replace time-consuming manual steps and cross-team interactions, Scalefocus built additional system-to-system interfaces that improved the reliability of the operation.

Results

Transparency is a key requirement for the ASO business and with the implementation of the new Claims Settlement System the client got greater visibility into their claims expense at various levels of detail. Our team eliminated the inefficiencies of the infrastructure involved in the ASO processes resulting in a faster, cost-optimized and error-free operational flow. The automated solution we built for claims settlement and billing operations is fully integrated into the enterprise portfolio for system-to-system interaction. It allows for flexible and rapid introduction of new services and products to the market and makes it possible to react to changing market needs and gain greater customer trust. The implementation of the cloud-based Claim Settlement System transformed completely the complex process of stringing together ad-hoc and sub-optimal tools into а smooth and stable reprocessing and reconciliation, invoice creation, transmission and storage. The system also optimizes claims performance by balancing process automation with access to human help if customers need it.



Value delivered:


  • Automated, faster and accurate creation of invoices

  • Achieved less human interaction and reduction of manual work by 80%

  • Minimized errors and cut down processing time by 50%

  • Reduced processing costs and accelerated payments

  • Ensured full transparency resulting in better visibility for clients

  • Established common definitions and consistent language across claim settlement processes

Our Work

We have a global client base that includes Fortune 500 companies, innovative startups and industry leaders in Information Technology, E-Commerce, Insurance, Healthcare, Finance and Energy & Utilities.

Next Level DevOps Maturity with Azure DevOps Server

Healthcare & Life Science

Next Level DevOps Maturity with Azure DevOps Server

Building Resilience with Offshore Software Development Center

Healthcare & Life Science

Building Resilience with Offshore Software Development Center

Achieving Two Times Higher Productivity with Fully Redesigned UI/UX

Healthcare & Life Science

Achieving Two Times Higher Productivity with Fully Redesigned UI/UX

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Scalefocus exists to bring innovative tech-centric software solutions, which exceed client expectations and bring excellent, scalable results.