CASE STUDY/ INSURANCE
NextGen IT Operations | Digital Transformation Services
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A leading employer-sponsored health insurance provider in Latin America.
in the market
Our client needed a consulting partner to conduct a process assessment of all systems related to the treatment approval process. Information about medical benefits, coverages, and treatments was not centralized, which did no favors to internal auditors, beneficiaries, and personnel managing and updating the approvals. After an unsuccessful attempt with a prior consulting partner, our client was looking for a much more detailed roadmap of short- and long-term initiatives with the goal to:
Identify gaps between current operations and member expectations in the authorization management process.
Minimize rejections (for treatment, medications, claims, etc.) by addressing information gaps, reducing friction, and enhancing process efficiency.
Reduce response times for medical practices and give internal auditors the tools to measure authorization and treatment effectiveness.
Improve the retrieval of beneficiary information to improve decision making and execute more preventative campaigns targeted at the healthy population.
Within a timeframe of fewer than two months, Softtek conducted a series of workshops with key IT and business users to gather vital information, conduct a comprehensive assessment, compile findings in a project repository, and deliver an executive presentation contextualizing all results. Softtek focused on two key areas during the assessment: the approvals process and obtaining a beneficiary 360 view.
4-phased assessment based on the Customer Value Assessment (CVA) methodology: included planning the workshops and interviews, gathering artifacts, process mapping, risk and financial analysis, UX prototyping, and defining current and future states for each process and system.
Delivered a detailed roadmap of improvements to current systems/processes and new actions to implement. The roadmap included a thorough cost-to-benefit analysis of all initiatives. It also considered the viability of each initiative in terms of IT, workforce, and business readiness for change, among other factors.
The creation and delivery of a weighted and prioritized roadmap empowered the client to systematically approach each initiative with confidence and precision.
Identified quick wins to deliver immediate value to the authorization process and beneficiary information platform, resulting in enhanced efficiency and service quality.
Improved management of member information by prioritizing technological solutions to effectively manage and track services consumed by members.
Gained key insights to improve the beneficiary experience through a faster process and more intuitive user experience.
Gained insights to improve visibility for internal audit processes through process automation and more accurate and reliable data.