Case Study

End to End Claims Management for a leadinginsurer and benefits administrator in US

Insurance

When this major health insurer decided to refit its less efficient claims processing system, there was a further need to streamline every sub process of the entire claims cycle. Workflows had to be redefined to handle volume spikes and technologies introduced to enable accuracy and overall throughput. The client was also looking at reducing costs signficantly maintining quality, accuracy and timelines of processing claims.Operational challenges included managing varying volume of claims, processing standard claims as well as non-formatted claims. Since the process was manual, another requirement was to eliminate inaccuracies arising out of manual intervention.

The Challenge

Hexaware implemented a State-of-the-art People-Process-Technology solution to perform all claims processing services by migrating the current processes with minimal or no impact to business operations. The solution included full suite of services that covered the requirements for mailroom services, storage and retrieval, digital imaging, data entry, preadjudication and adjudication. Hexaware proposed a best fit working model to the client:

The Solution

Phased Transition of Mailroom + Data Capture, Pre-Adjudication & Adjustment Process

Digitization

Mailroom, Scanning and Indexing

Pre-Adjucication Adjudication

Claims Tracked, Captured and Reported

Using hNext (Hexaware Platform)

Verification and Quality Check Performed

EDI 837 Claims Uploaded to client system

Member Patient Details Verification

Provider Details Verification

Claims Details Verification

Repricing Routing

Provider Maintenance

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Business Benefits Delivered

Facts and numbers

Cost savings: ~45%

Accuracy: Expected – 95%; Delivered 99.5%

Productivity Improvement: 5% YOY with benefits passed on to the client

Reduced transition timelines by 2 weeks for simple processes and 4 weeks for complex processes ~ Improved TAT

Robust documentation & Process Mapping

11 - Years of engagement

6 million+ Claims transactions

handled per year

$1.8 Bn - Total payout

9 - No of locations supported

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About HexawareHexaware is the fastest growing next-generation provider of IT, BPO and consulting services. Our focus lies on taking a leadership position in helping our clients attain customer intimacy as their competitive advantage. Our digital offerings have helped our clients achieve operational excellence and customer delight by ‘Powering Man Machine Collaboration.’ We are now on a journey of metamorphosing the experiences of our customer’s customers by leveraging our industry-leading delivery and execution model, built around the strategy— ‘Automate Everything, Cloudify Everything, Transform Customer Experiences.’ We serve customers in Banking, Financial Services, Capital Markets, Healthcare, Insurance, Manufacturing, Retail, Education, Telecom, Professional Services (Tax, Audit, Accounting and Legal), Travel, Transportation and Logistics. We deliver highly evolved services in Rapid Application prototyping, development and deployment; Build, Migrate and Run cloud solutions; Automation-based Application support; Enterprise Solutions for digitizing the back-office; Customer Experience Transformation; Business Intelligence & Analytics; Digital Assurance (Testing); Infrastructure Management Services; and Business Process Services. Hexaware services customers in over two dozen languages, from every major time zone and every major regulatory zone. Our goal is to be the first IT services company in the world to have a 50% digital workforce.

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