Workers' Compensation: Return-to-Work to Drive Savings, TAT, and SLA Excellence

Today's carriers must gain effective strategies for managing financial challenges inherent to workers' compensation provision, including increased competition, staffing requirements, and transformation. These carriers are increasingly turning to BPOs as an option that brings cost-containment, TAT, and SLA excellence to these insurers.

Through our innovative workers' compensation solutions design, mix of shoring methodologies, and transparent operations, HGS has proven over time to positively affect our partners' operations in ways such as improving bill accuracy to an organizational average of 99.80 percent, an improvement over the 99 percent standard per URAC. As a result of these program improvements, HGS is proud of our 100 percent client retention rate.

How We Do It

Our services are supported by 65 locations onshore and offshore, with a full-service fulfillment center. Our licensed and bilingual agents provide 24x7x365 phone coverage and full service claims support. Today, 650 employees, including 70 RNs and 80 Coder Reviewers, support workers compensation programs.

HGS offers a suite of capabilities across the workers' compensation claim lifecycle, including:

  • Medical Bill Review
  • Key From Image
  • Re-Evaluations
  • Complex Clinical Reviews
  • Medical Relatedness and Rarity
  • Code Review
  • Provider Contact Center
  • Telephonic Case Management
  • Provider Data Management
  • Independent Medical Evaluation (IME)
  • Medical Records Case Prep
  • Durable Medical Equipment Confirmation Calls

Our Value

Partnership Success

  • For a global general and life insurer, HGS solutions, such as Complex Nurse Review and Code Review, have achieved significant savings for this client. HGS initiated an Accurate Coding mechanism that supported approximately $3.5 million, to date. Additionally, CSAT scores for HGS have been at 100 percent consistently for the past five years due to the value creation and process improvements.
  • Our engagement with another leading insurer started in 2012, when we provided crucial insights and expertise to improve efficiency through a Smart Advisor platform, via another satisfied client. This client partner provided HGS an opportunity to provide services for a short-term medical bill review project, which enhanced the confidence to initiate a long-term partnership with us for workers' compensation back-office capability.

This project went live in Feb 17, 2014, with 10 FTEs handling one of their service clients and in the past two years, HGS has successfully handled 23 independent clients on the platform supporting medical bill review services. Today, an 80-member team provides services for multiple LOBs such as KFI (Key-from-Image), Medical Bill Review, Reconsiderations, Code Review and Nurse Review, and Provider Management from our off-shore service delivery location in Bangalore, India. HGS designed an effective two-week training plan, four-week ramp-up plan, and well-organized robust implementation methodology for seamless transition and steady state operations, resulting in 100 percent CSAT scores for the past two years.

"HGS has exceeded our expectations and we look forward to our continued partnership."

Director, Service Center Operations

HGS Accurate Coding to save approx. $3.5 million

of Top Healthcare Payers Supported
Healthcare Professionals
Serving Members on behalf of Payers and Providers
Industry-Leading Compliance
100% Client Retention