Insurance Plans
| Project Background | A major health insurance company serving nearly 50 million members with over 24,000 providers and annual revenues of over $2 billion. 400 CSRs in two locations linked as a virtual center. Company regularly ranks among best in class in customer service and employee satisfaction |
| Business Challenge | Advice sought by management on right number and sizing of call centers. Need to increase scheduling efficiency without negatively affecting agent morale. Required independent assessment of overall call center performance. |
| Project Approach | • Two person project team led a six week assessment of the two call center locations • Analyzed call center data and metrics • Conducted interviews of key personnel from senior management to frontline employees to gain perspective on current operations • Assessed technology, quality program, organizational structure, and processes for scheduling and performance assessment • Observed agents handling voice and email contacts, and observed supervisors and managers in action |
| Business Benefits | The assessment yielded several key recommendations which included: • Changing Organization Structure • Revising Quality Program and Coordinating Quality Process between Supervisors and Monitors • Redesigning and Replacing Call Center Technology to Better Support Call Routing and Improve Disaster Recovery Capabilities • Redesigning Performance Measures and Integrating into Schedule Bid Process • Redesigning Performance Reporting System to Reduce Technology Risk |
| Project Background | A major provider of health insurance – member of a national association of health care plans. The company delivers individual and group health plans and third party administration services to large clients |
| Business Challenge | Sales and enrollment process was overly complex, didn’t meet different needs of different customer segments |
| Project Approach | Two person project team worked with cross-functional team of client staff, departmental management, and executive management over six months to: • Determine client expectations and appropriate metrics for the process • Map core activities and develop “as-is” process maps • Review process disconnects and design new “to-be” process maps • Develop system requirements necessary to support re-designed process • Create new roles, position descriptions, and organization charts for affected departments • Develop implementation plan and business case for required investment |
| Business Benefits | • Client implemented recommendations in Marketing, Underwriting, and Customer Service departments to improve service and reduce cycle time • Customer Service recommendations reduced abandon rates from 12% to 2% and improved service levels without hiring staff • Process analysis and business case justified necessary staffing increases and new positions in Marketing and Sales • System requirements incorporated in RFP for new system by client’s IT department |
| Project Background | Major health care provider known for providing outstanding customer service and operational excellence |
| Business Challenge | • Growth in volume led to performance of the claim process becoming unstable and unpredictable as real-time workflow reporting and process information were not available to process owners or participants • Growth and acquisitions were pushing current process beyond its capability to meet member and provider SLA’s • Claim Processor Supervisors and Sr. Claim Processors were spending too much time collecting, integrating and defining workflow data and as a result they were not spending time coaching and developing employees |
| Project Approach | • Two person project team worked with cross-functional team of client staff, departmental management, IT, supervisors, process subject matter experts and executive management over 5 weeks to: • Benchmark “As Is” claim process metric/report capability (inventory current metrics and criteria for claim process) • Design “To Be” claim process metric/report (Dashboard and Scorecard) requirements • Identify gaps between “As Is” and “To Be” metric report states • Provide Level-1 “As Is” process map to identify process Key Performance Indicators (KPI’s) and Performance Indicators (PI’s) • Establish metric/report standards for claim process that align with corporate values and strategies (Operational Excellence & Growth) • Develop Level-1 “To Be” process map utilizing BPM best practices • Provide Findings/Recommendations/Industry Best Practices |
| Business Benefits | • Identified metrics that provide real-time visibility and process control • Recommended Implementation of BPM solution that automatically prioritizes and routes work • Brief review identified over $1,000,000 in cost savings, risk reductions, and process improvements • Projected return on investment based on action plans of 500%, payback in less than six months |
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