Our Successes

Background: A healthcare insurer was responsible for processing over 3 millions claims annually. The majority of claims were adjudicated and a significant number were readjudicated due to system configuration issues, manual processing errors, and medical management review. The company was seeing significant expenses due to prompt pay, large staff was required to try to keep up, and team members were shifted frequently to address high queues.

The needs: The company had to be able to find ways to pay these claims timely, free up claim processor time to focus on initial claims payments, and reduce prompt pay penalties. This required a complete rebuild of the claims readjudication process. 

The results: Within 9 months, a custom application was designed, developed, and implemented. Staff was trained and documentation and integrated reporting was developed. The new system had built-in security, auto-assign work, built-in business rules, validation, metrics programming, reporting, internal escalation process, and the generation of claims files.

• • Annual $6 million savings in cost avoidance and administrative savings;
  • Corrected regulatory reporting and files; and
  • Enhanced custom application.

>> Lean Six Sigma  >> Application Development  >> Training  >> Cost Avoidance  >> Regulatory

Background: Company with over $3 billion in revenue continued to have failed software implementation of regulatory supported application. Multiple attempts had failed implementation over a six year period.

The needs: Regulatory requirements and overview was increasing, penalties were increasing, and manual processes were becoming burdensome. Software add-ons were needed and requested to be completed promptly.

The results: 

• • Project completed and tested within six months;
  • Company was immediately able to run millions of records through the system;
  • An estimated $2 million was saved over a three year period; and
  • The company was compliant with state and federal regulatory requirements.

>> Project Management  >> Software Implementation  >> Regulatory

Background: A major regional healthcare insurance agency was implementing strategic alignment of departments to optimize medical cost ratio and align staffing to industry benchmarks. Departments had to improve efficiencies while establishing significant administrative savings, a major shift in philosophy as historically the company favored service to the community by employing more local talent.

Most employees had been with the organization for decades, exhibiting complacency and making moderate improvements. Due to the large number of employees, efficiencies and review of processes was uncommon, thereby, leading to significant waste and manual processes.

The needs: A complete paradigm shift was in order including culture, strategy, workflow, systems, training, and metrics. The company held the strategy to significantly reduce overall costs within six months.

The results: A collaboration with senior leadership led to realigning change management solutions and addressing the change in culture, reviewing of end-to-end workflows, training provisions, and the development of training for staff in new process and tools.

• • Administrative savings of 43%;
  • Increased team throughput by 120%;
  • Implemented career paths; and
  • Increased team morale. 

>> Change Management  >> Lean Six Sigma  >> Project Management  >> Sponsorship  >> Strategic Alignment

Background: An enterprise covered multiple locations across three states. Historical information identified that the organization was losing millions, delayed projects were causing budget constraints and overages, and resources were stuck on projects taking them away from production work and other critical functions.

The needs: A change management methodology was required to improve the success level of projects and implementation. Change management would address the people side of the implementation allowing for raising and addressing resistance, correct sponsorship, understanding and incorporation of business and human objectives, and developing projects that meet all core requirements. Internal teams needed to be trained in methodology and tools, and the creation of a roll out plan to over 2,000 staff as well as a review process was developed.

The results: Seven internal coaches were certified, pilot projects were selected to showcase methodology and its effectiveness, and trainings were held for leadership, project, and operational teams. 

>> Change Management  >> Project Management   >> Strategic Alignment

Background: Senior leadership was getting complaints about the credentialing and recredentialing of the providers within their network. Timeframes were not being met, quality was poor, and there was a high turnover of staffing.

The needs: The development of a streamlined process that included visibility into receipts, file in queue, quality, and the proactive review of potential timeframe issues. Leadership also needed a dashboard to present to executive leadership. 

The results: A combination of change management and lean practices were implemented to review workflow and develop an automated solution. The team helped design the process, address the challenges, and test to reduce waste and improve quality.

• • Team throughput increased by 220%;
  • Elimination of 35% of process time; and
  • Provided accurate and timely KPIs, KRIs, and dashboard reporting.

>> Workflow Management  >> Lean  >> Automation  >> Strategic Alignment  >> KPI and Dashboard

Background: A software company was running international and domestic development teams to support their primary products. The domestic team was consistently missing timeframes resulting in delayed releases and frustrated customers. 

The needs: As new customers were coming on, it necessitated improved delivery of software updates, enhancements, features, and addressing bugs. The company had to address current client needs while simultaneously improving the product to increase market share.

The results:

• • Product owner was able to focus on product development;
  • Release cycles were expedited from quarterly to every three weeks;
  • Client engagement and satisfaction rose significantly; and
  • The team became engaged and self-oriented.

>> Software Development Life Cycle  >> Application Development  >> SCRUM  >> Release Cycle