INDUSTRIES
Healthcare Insurance
Healthcare insurance organizations use Comprehend to improve claims operations, auditing practices, and membership and enrollment functions resulting in immediate cost savings and increased profitability.Challenges
Administrative costs for Health Insurance providers exceeded $91 Billion in 2009. A large portion of costs were directly related to claims processing, with the average manual claim costing $2.05 to adjudicate. There are over $50 Billion in overpaid claims each year. Errors in claims can result in not only overpayments, but underpayments that can even be more costly due to penalties and interest costs associated. Additionally, a large part of administrative costs are driven through contact centers where multiple systems and applications are required to service customers, rework is high, and self service adoption is low. Improving the productivity and service provided by operations will be critical to competing in the changing insurance market.
Solution
The OpenConnect Comprehend solution provides the detailed event-based intelligence around the complete claims operation and member service process.- Comprehend Workforce Reporting and Analysis provides real-time metrics into worker productivity and operational inventory.
- Comprehend Workforce Intelligence provides event-based analytics on the exact productivity and costs due to manual work in claims operations.
- Comprehend Process Intelligence provides a complete view of the end-to-end process (from claim submission all the way through payment) to quickly pinpoint and resolve rework and process bottlenecks.
- Comprehend Automation provides “virtual examiners” to automate manual processes and free your human capital to focus on improving service levels.
- Comprehend Customer Intelligence provides a detailed view of the entire customer process and experience to pinpoint specific areas of improvement.
Benefits
OpenConnect Comprehend provides quantifiable results, improves claims operations immediately, and has a positive ROI within one-year of deployment.
From a claims operations perspective, OpenConnect Comprehend allows healthcare insurance organizations to:
- Lower cost of manual adjudication
- Reduce SLA penalties and interest
- Reduce processor FTEs
- Improve Time of Service
- Lower cost of manual audit
- Improve quality, fewer adjustments
- Quicker sispute resolution
- Improve Agent productivity
- Improve portal adoption rates
- Improve customer service satisfaction
- Reduce call volumes
- Reduce mail related expenses
With Comprehend you can improve your Operational First Pass Rate, decrease adjustments and rework, reduce penalties and interest, and lower your administrative expense while improving customer service.
Key Customers Include:
- Wellpoint Health Networks
- Horizon (BCBSNJ)
- Henry Ford Health Systems
- Blue Cross Blue Shield Minnesota
- Blue cross Blue Shield Florida
- To Learn More About Our Customers...
Case Studies:
Use of Comprehend to improve Operation First Pass Rate resulting in decreased cost, processing time and increase in quality.
Use of Comprehend's event driven intelligence to drive portal adoption rate and reduction of call center and traditional mailing costs.
Analyzing root cause of work and process inefficiency during claims operation through adoption of Comprehend's workforce intelligence capabilities
Comprehend Solutions Brochures