Case study– Health plan reduces claims operations costs by $11 million

Case Study—

Health plan reduces claims operations costs by $11m plus improved their auto-adjudication by 20%

A Midwest health plan provider with just over 400,000 members. Their lines of business include commercial, Medicare Advantage, and Managed Medicaid.

Before collaborating with Catalyst, the health plan incurred claims-related expenditures of about $16.5m annually.

Catalyst provided outsourced claims processing, configuration, and a machine learning application. Once the claims work was outsourced to Catalyst, Catalyst conducted an exhaustive review and optimization of the health plan’s configuration.

Catalyst improved their auto-adjudication from 65% to over 85%. Additionally, they integrated Catalyst’s machine learning solution, eliminating the need for human intervention in almost 92% of claims. These technological innovations, coupled with Catalyst’s highly trained and highly efficient resources, reduced the health plan’s annual claims operations costs by almost $11m annually.

Insurance companies are reliant on two main pillars — bringing in new business and claims administration. Claims administration is a significant responsibility. Any new customer that signs onto a policy is doing so with the confidence that their claim will be processed fairly and quickly, should the occasion arise.

Given the importance of claims administration, many insurance providers are choosing to outsource the process of claims administration to specialized experts like Catalyst Solutions. Learn more about out why outsourcing claims administration makes good business sense.

Catalyst aligns our outsourcing services to your business goals and uses our industry expertise to anticipate your long-term needs. Our services don’t end with outsourcing. We become your trusted advisor and collaborate with you in achieving a better future.

Catalyst believes true success in a BPO relationship can only be built on collaborative partnerships. Our mission is to extend our competencies and scalability to help your health plan focus on what really matters, so much so, that we are willing to build financially-based service level agreements into our contracts. This means we put our skin in the game. Together we share both risk and reward.

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