case studies

Case Studies
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
Clients
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