Optimizing Health Insurance Claims Processing Through Data Analytics
The client is a US based non-profit health insurance corporation which insures more than 2 million people in four states. The entity processes a daily volume of around 85,000 pended claims, 29,000 fully insured pended claims, around 1,900 claims aged inventory greater than 30 days. They faced various challenges in the claims processing center due to scattered data and lack of centralized system. Prompt payment on insurance claims is required by regulatory authority with penalties if delay exceeds a threshold. Manual claims processing workflow can be complex, with multiple departments/agents involved. They chose CloudMoyo to overcome these challenges, which developed integrated dashboards and views for executive and process owners to track the ongoing status for aged Inventory of claims with automated heat maps. It increased visibility into pending claims that require attention, reduced average processing time, ultimately, cost savings to the tune of 500,000 dollars annually in reduced penalties.