Leading healthcare provider ensures a faster, more effective claims processing operation
Company Size
1,000+
Region
- America
Country
- United States
Product
- Mattersight® Desktop Analytics
Tech Stack
- Secure Cloud-Based Analytics
- SaaS Delivery
Implementation Scale
- Departmental Deployment
Impact Metrics
- Cost Savings
- Customer Satisfaction
- Productivity Improvements
Technology Category
- Analytics & Modeling - Predictive Analytics
- Functional Applications - Enterprise Resource Planning Systems (ERP)
Applicable Industries
- Healthcare & Hospitals
Applicable Functions
- Business Operation
- Quality Assurance
Use Cases
- Predictive Maintenance
- Process Control & Optimization
Services
- Software Design & Engineering Services
- System Integration
About The Customer
The client is one of the top 5 healthcare providers in the United States, employing over 100,000 individuals and serving more than 50 million members both domestically and internationally. As a leading entity in the healthcare sector, the client is responsible for processing millions of claims annually. This task is critical as it directly affects the financial and emotional well-being of their members, who often find the claims process overwhelming and confusing. The client is dedicated to ensuring that their members have a positive and efficient experience when dealing with medical claims, which is a significant aspect of their service offering.
The Challenge
As one of the largest healthcare providers in the United States, this client processes millions of claims each year, which means they impact their members’ lives at a particularly sensitive point: the intersection of health and finances. People trying to understand and negotiate a medical claim are frequently overwhelmed, confused and even frightened by the paperwork and dollar amounts they’re dealing with. So this client is committed to providing those members with an experience that is as efficient and positive as possible. The pressure on agents to process claims quickly and accurately was high, and managers could see that somewhere along the line, something was breaking down. Individual processing time was slowing down, and fewer claims were being processed overall. But without any way to identify the specific causes of the problems, they were powerless to fix them. This client needed a clear understanding of their claims processing problems, and a concrete set of tools to quickly solve them. So, they enlisted Mattersight.
The Solution
The client partnered with Mattersight to implement Mattersight® Desktop Analytics across an initial subset of its claims processing agents. This solution provided managers and supervisors with an unprecedented framework for improving the quality and effectiveness of their operations. A detailed analysis of previously uncaptured desktop activity brought a new level of clarity to how agents were spending their time. Self-reported activity was now objectively measured and scientifically analyzed, and unstructured time was broken out and categorized by metric. The output of this analysis was delivered to supervisors in real time, through a dynamic performance dashboard. These new insights revealed the true 'why' behind agents’ performance variability and empowered managers to reduce it. Inefficient business processes that impeded performance were identified and corrected. Risk-elevating actions related to compliance and non-authorized computer use were flagged and addressed. Supervisors were able to provide coaching and feedback focused only on an agent’s best opportunities for improvement, using examples of the agent’s own performance to illustrate target behaviors and strengthen understanding.
Operational Impact
Quantitative Benefit
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