$700 Million in Cost Savings
One of the top five healthcare payers in the U.S., this client was looking to improve their customer experience by transforming from providing as-needed, claims-based interactions to more proactive, preventative healthcare assistance. They wanted to focus on delivering better member-centric services and helping customers get to the right answer fast while resolving claims more quickly and reducing paperwork and costs.
What We Did:
HGS initially was engaged to deliver voice and non-voice service for two of the client's processes, including enrollment and platform 1 pre-adjudication and adjudication. This service solution was launched with 15 agents and over 12 years, has grown to support over 95 processes with close to 6000 agents.
By ensuring front and back office integration, HGS was able to help this client provide seamless, accurate service and resolve claims more quickly. Expert resources such as nurse triage and wellness coaching were added to focus on the customer's needs. And robotic process automation helped reduce costs while increasing productivity and getting the customers the answers they need.
- Saved nearly $700 million, via both overpayment and underpayment efforts
- Achieved 97 to 99% score on client-defined metrics for all lines of business
- Reduced the number of contacts by 94%
- Reduced claims rework by 5% and claims denial by 3%
- Increased transaction accuracy by 18% and decreased instances of missing information by 18%