Case study– Health plan achieves 22% increase in claims processing productivity

Case Study—

Health plan achieves 22% increase in claims administration productivity with $740k annual savings

Insurance companies are reliant on two key functions — 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 claims will be processed fairly and quickly, should the occasion arise.

Who:
An East Coast health plan with just over 600,000 members. Their lines of business include employee-owned/employer sponsored, individual and family health, employee assistance, Medicare Advantage, and Managed Medicaid.

Challenge:
Before collaborating with Catalyst, the health plan incurred annual claims-related expenditures of about $13.4m annually.

Solution:
Catalyst contributed as a strategic partner. Not only did we clear out the client’s aged inventory and perform COB adjustments as mandated by the state, but we also undertook an effort to optimize the client’s processes, driving additional efficiencies, and provided recommendations to their configuration that:

  • Kept the plan compliant with regulations
  • Optimized their auto-adjudication rates

Results:
Once the claims administration work was outsourced to Catalyst Solutions, the health plan experienced an increase in claims processing productivity of almost 22%. The total annual savings was just under $740k.

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 and consulting 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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