Leading Health, Life and Benefits dministrator in the US

1. Case Study Healthcare & Life Sciences
Leading Health, Life and Benefits Administrator in the US
Client Overview
The client is a leading health, life insurer and benefits administrator and was in need of a long term trustworthy and professional partner. Located in the US,
the client has been in service for almost a century. They are a USD 100 mn+ company with a massive employee base of more than 600,000. They have an
entire gamut of products and services catering to the needs of small, medium and large customer groups across Healthcare & Insurance domain.
Solution Framework
The Challenge
It has been three years now with a mutual win-win partnership with our client, flexible
Increasing cost on human resources and
enough to adapt to their changes. Almost 70% of their back office healthcare business
operations in a high cost location
is currently outsourced to us with a single vendor strategy. We undertook pilot
Increased operations due to the recent expansion
operational plans for each of the process outsourced to us and deployed scalable
of business
resources to take care of the future needs. We have currently 350 fulltime resources
Need for improved turnaround time and overall
dedicated to the project and we are maintaining additional 50 buffer resources.
work efficiency
Need for partner-in-business approach
considering their rapid expansion
Need for a vendor who has deep expertise
enabling seamless transition in a reduced time
span
Q4 2006
Q4 2005 Adjudication Value add
Re-pricing process
Q3/Q4 2004
for We addressed the client issues in a highly
Pre- additional
processing locations professional manner enabling them to achieve the
of claims for
Q1/Q2 2004
the exisiting following benefits.
Data locations
capture for
3 locations Reduction in the turnaround time by 50%
Hexaware Approach Cost reduction of around 40% and accuracy in
Transition– Trans X: Our proprietary tool for transition was deployed for the project claims handling of 99%
transition Consistent adherence to the internal audit
‘Wave Implementation Approach’ was used where processes were migrated in a compliance for quality of 99.99%
phased manner Our highly skilled transition team could complete
“Virtual Transition Team” was setup offshore for successful migration and the entire transition in less than three months
implementation
Resources required for the project were trained in
Value Engineering: This team facilitates process measurement & re-engineering,
less than half the time
increased quality & productivity and reduction in the overall cost
Technology: The project required deploying “Hybrid Solution” consisting of both The resource pool of 350 employees required for
online & offline modes of processing. We logged on to the client system using secured the project was cross trained to take care of any
VPN connectivity fluctuation
Diagnostics: D-Consult, “Know How” and proprietary methodologies were utilized for Online Dashboard was provided for monitoring
high end diagnostic studies
work status and reporting and also served as a
Innovation Labs: Proprietary tools and capability boosters like Fetch
(Autodownloading tool) Allocate X (Real time work allocation tool), Optimal central repository for all the documents
QC(Quality Control Tool) , ProTrak (Online workflow management tool), etc. were Exceedingly high audit compliance- The audit
deployed compliance is 99.99%.
The various sigma levels for the processes managed by us are given elow in the table:
Initial Sigma Improved
Levels Sigma Levels
'DWD &DSWXUH
Pre-processing
Adjudication
© Hexaware Technologies. All rights reserved. www.hexaware.com