Industries Served & Case Studies

Health Insurance

CASE STUDY: Improved Profitability and ROI from CPI

Problem

Inconsistent quality and communications barriers did not allow optimal shift of process work to offshore vendors, reducing ROI and delaying overall required cost reductions.

Situation

Our US health claims processing customer was not able to realize the full ROI and reduced staffing benefit of BPO offshore outsourcing due to less than optimal quality from various offshore vendors, until they teamed with CPI. The services involved basic back-office functions to higher skill Knowledge processes regarding COB/EOB coding, attachment and exception processing, Medicare EOBs, secondary payer adjudication, and non-standard document ID and routing.

The customer projected reducing in-house quality control, training and vendor communications staff by 75% (25 FTEs), but could not implement the plans since the vendors never delivered the expected accuracy on a consistent basis. The customer also needed to send trainers oversea to introduce new or improved processes. A plan to shift additional pre-processing work to offshore vendors, to further reduce overhead, was also put on hold.

Results

With CPI, the customer began to achieve the targeted quality, communications and cost reductions.

• CPI's US based project management staff was able to handle project set up and training much more thoroughly and quickly than using Web-Ex or traveling to offshore locations. Questions were answered in half the usual time. The customer had never experienced such a smooth start-up.
• CPI, using very experienced staff, was able to implement the EOB/COB coding tasks almost immediately, with training only for the unique business rules.
• CPI's IT department was able to install customer servers and software quickly and easily, and help to refine, debug and troubleshot the systems and program updates.
• CPI was able to staff 24/7 and become a full part of the customer's 24 hour workflow and pre-processing work staff.
• CPI was able to assist with quality review for other vendors.

Our customer reduced or re-deployed in-house staff performing QC and claims processing by 70%. They also reduced the number of outsource vendors from four to two, as CPI ramped up to over 100 staff in less tan 4 months.