Case Study

Web-based Application Development for a Fortune 100 Health Insurance Company Drives 94.2% Reduction in Multiple Reach-outs to Brokers and Members


About the Client

HGS partnered with a US Fortune 100 Health Insurer to deliver voice and non-voice service for two of its processes, including enrolment and platform 1 pre-adjudication and adjudication.

  • Lines of business: Medical, dental, Life, Vision, LTD, STD, Specialty Operations
  • Types of submission: Paper and Electronic
  • Information required:
    • Group information
    • Employee information
    • Wage and Tax ID
    • Sold quote
    • Agent information (commission details)
    • Prior coverage information
  • Turnaround time: 1.5 days for review; 1.5 days for data entry

What the client was looking for…

This client’s case installation process was confronted with a series of customer information management challenges, all related to the complexity of enrollment and the wide variety of insurance products under consideration. The following problem areas were identified as particularly pressing:

  • Handwritten applications
  • More than 6,600 possible information fields across all insurance types
  • Need for multiple clarification and information requests to complete new records

These problems created serious customer experience problems for both insurance brokers and members. Additionally, the work required to amend and complete new patient records created delays in turnaround time for new accounts. For this process, this client asked HGS to achieve the following specific goals:

  • Increase accuracy in data gathering
  • Increase efficiency in data completion
  • Decrease cycle time

How HGS delivered…

Based on our extensive experience with complex process consulting, HGS built an agent-friendly, web-based application, which helps to generate a detailed missing information database for all new members. This database was paired with a CRE tool that reviews all information collected before drafting, formatting, and populating individualized missing information letters, to be sent to new members as necessary.

How the business transformed…

Once our new tool was in place, HGS saw immediate and impressive results against all of the goals mentioned above:

  • Accuracy in data gathering - 18% increase in overall transaction accuracy during the first 12 months after inception
  • Efficiency in data completion
    • Year-over-year reduction of 94.2% in the need for multiple reach-outs to brokers, members, and client sales team for missing information
    • 18% reduction in missing information requests during the first six months after inception
  • Cycle time - 25% reduction


Missing Information questions

Multiple reach-outs

Cycle time