CASE STUDY
Industry:
Health Insurance
Products / Services:
Member360, Revenue360, Broker360, eEnroll
Managing and Transforming a BCBS Organization in Caribbean
Client Background
The client is an esteemed healthcare insurance company and a distinguished Health Maintenance Organization (HMO). The client caters to diverse market sectors, encompassing Medicare, Medicaid, group and Individual within the Caribbean region, ensuring comprehensive healthcare coverage for all segments.
Client Requirements
With a customer base of 100,000+ members, client was facing issues with Correspondence automation as well as processing of State data. The client aims at staying compliant with CMS based on regulatory mandates. Other challenges include, Non-domain centric applications as well as multiple non-integrated applications.
Automated 95% of data processing
Increase in CMS star ratings to 4 within Medicare operations
Reduction of staff during AEP high volume periods
Solution Highlights
With the full integration of the platform with CMS and State, the customer was able to automate correspondence including processing of State data. The solution not only modernized their operations but also positioned them for enhanced productivity and CMS compliance.
Single
Platform
Delivered four applications with full integration between CMS and State processing for Dual membership
Integrated
Solution
Integrated various applications including Broker, Membership management, and member’s Finance enterprise
Eligibility &
Enrollment
Streamlined Medicare operations for electronic enrollment and eligibility processing
CMS
Compliance
Helped in compliance with CMS regulations through audit trail & CMS compliance reports
Improved
Efficiency
Standardized execution practices and improved service levels across various businesses
Correspondence
Automation
Enterprise Correspondence processing for both Member and Provider based on CMS regulations