APPLICATIONS TECHNOLOGY SERVICES CUSTOMERS PARTNERS NEWS/EVENTS COMPANY


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 will exceed $91 Billion in 2009. A large portion of this is directly related to claims processing, with the average claim costing $2.05. There is also 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. Additionally, a large part of administrative costs are driven through contact centers. Less than 5% of all health insurance customers have opted out of traditional mailed information. Add to this the call center costs as members and providers seek out information and the costs are staggering.

Solution

The OpenConnect Comprehend solution provides the detailed event-based intelligence around the complete claims operation and member contact process.
  • 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 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:

From and auditing and fraud perspective, OpenConnect Comprehend allows healthcare insurance organizations to: From a membership and contact center perspective, OpenConnect Comprehend allows healthcare insurance organizations to: