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Commercial mortgage case study I

This case study clearly illustrates how a mortgage company made the decision to outsource their business processes to Silverskills and the benefits...more


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Silverskills’ domain expertise in financial & claims processing services coupled with an unrelenting focus on client satisfaction...more

Healthcare adjudication case study

Client: The client is a leading, national Third Party Administrator in the US that focuses on improving the administration process for self-funded employers and insurance companies. The client has over 74 employer groups constituting over 150,000 members

Challenge:
The TPA needed a partner who could:

  • Consolidate different data management processes
  • Enhance their legacy systems with new technology tools
  • Build reporting and performance metric tools which were non-existent
  • Improve service levels in terms of claims payouts
  • Reduce the cost of claims inaccuracies

The time frame that the TPA was looking for to observe these results was within a few months

Silverskills solution:

Silverskills used its outsourcing experience, technological strengths and domain led process capabilities to implement its solutions. These included:

  • Modifying the systems to improve efficiency, reliability and increase automation
  • Build web based application layer over the legacy systems to improve functionality
  • Build additional dashboards and performance metric tools to provide base for continuous process improvement
  • Implement robust and proven offshore delivery model for delivery of services from India.

Processes:

  • Data capture of claims received from the TPA, including typical medical forms and those received from hospitals such as HCFA, UB92, Dental, Vision and FSA forms
  • Validation of claims in client’s software in accordance with the policies and rules pre-specified by the client
  • Claims adjudicated upon by the adjudicators who are well trained on taking decisions on health claims
  • Final payment decision (approve / deny)
  • Auditing of claims adjudicated

Benefits:

  • Augmented competence and accuracy of the claims adjudication process
  • Homogenized manpower requirement for the process by benchmarking competency parameters
  • Increase in auto adjudication of claims up to 40%
  • Improvement in process productivity by 30%
  • Reduction in turnaround time by 70% using “follow-the-sun” approach and Silverskills’s customized technology tools closely interfaced with the clients’ claims processing system.
  • Accuracy of payouts is 99%+
  • Productivity enhancement up to 20%
  • Cost savings of 40-50%
  • Access to large pool of domain experts
  • Access to latest IT tools & process innovations
  • Business agility to tide over surges & spikes
  • Automated workflow system incorporating Imaging created by Silverskills which helps all associates in being updated on the process progress on a minute-to-minute basis
  • Implemented an active first pass quality control system to minimize errors