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Composable Enterprise

CASE STUDY

Fortune 25 Healthcare Payer Reduced Enrollment Time by 50% via Intelligent Process Optimization

Industry

Healthcare and Life Sciences, Healthcare Payer

Our Contributions

Payer Business Process Optimization

Location

USA

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In the competitive U.S. managed care marketplace, reputation is everything.

Customer experience is closely tracked and reported, so companies offering health insurance plans to government-sponsored programs and private insurance markets need to ensure they go the extra mile.

One large healthcare company was having trouble onboarding new members, which was directly impacting its bottom line.

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The Challenge

The client’s enrollment process was overly complex, with data distributed across different systems, spreadsheets, PDFs, and templates. Complex manual workflows and high volumes led to delays in coverage, errors in paperwork, and dissatisfied customers.

They suffered from a high drop rate and customer complaints impacted their star ratings, which hampered business growth and decreased profitability.

To succeed in the marketplace, they needed to serve customers better and accelerate enrollment. They turned to Coforge for help streamlining workflows to accelerate application turnaround times and get their member enrollment process back on track.

Our Approach

 

We assembled a team of experienced plug-and-play industry experts to help optimize the health insurer’s existing processes. Our team implemented a digital-first approach focusing on workflow optimization, data-driven decision-making along with right skilling and right shoring to address these challenges.

We built a management information system (MIS) to provide effective work tracking, prioritization, and monitoring. We also implemented a flex/scale model and robust workforce training to ensure the team was ready to provide scalable support during peak enrollment times.

Management information system (MIS)
Provides effective work inventory tracking, priority and queue management with omnichannel capabilities for multiple intake sources.

Workforce distribution and tracking
Enhances monitoring and productivity with operational metrics tracking, dashboards and reporting.

Workforce optimization
Optimizes the workforce by cross training resources to enable scalability and dynamic load balancing during peak seasons, enabling faster turnaround time (TAT).

Training and development
Ensures a stable operational environment with robust training and certification programs, continuous learning and skill enhancement initiatives.

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Impact to Date

Since partnering with Coforge, the client has cut enrollment times in half and experienced a dramatic increase in its star rating. A new emphasis on quality has improved accuracy and reduced rework, while a metrics-focused approach has provided better operational visibility and business intelligence.

In addition, the new training programs have reduced onboarding time and ensured that staff are better trained to handle variations in workload.

50%

Reduction in turnaround time

20%

Productivity improvement

15%

Reduction in manual work

Coforge’s workflow optimization solution successfully transformed the client’s member enrollment process by enhancing efficiency and scalability, reducing costs, and improving customer satisfaction. Our structured approach streamlined operations and contributed to the client's overall business growth and sustainability.