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Case Study: Process Improvements
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An employer with
approximately 40,000 employees was experiencing significant claims and member
service problems with its primary national health plan supplier. These performance
problems caused employee dissatisfaction, required constant follow-up by
the benefits staff, and cost the client in excess of $1 million due to inappropriate
claim payments.
Objectives
- Develop and implement process improvement changes to eliminate root
causes of the service problems
- Re-structure performance guarantees to hold the supplier accountable
for specific results
Action
- The supplier developed, presented and implemented a "Service Quality
Improvement Plan" that restructured work flows and redesigned initial
and ongoing training programs
- The supplier agreed to initiate a monthly reporting process for both
internal staff and members of the client's management team to monitor
performance
Results
- Claims payment accuracy increased from 96.7% to 99.3%
- Average speed to answer wait times decreased from 41 seconds to 21
seconds
- Fees at risk for these performance measures were doubled to ensure
accountability
- For the first time in four years, the supplier met or exceeded all performance
targets
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