Offshore Managed Medicare Claims Work Achieves Near 100% Accuracy
Offshore Managed Medicare Claims Work Achieves Near 100% Accuracy
Industry
For health plans, efficient and effective back-office operations are crucial to success. Staffing issues like the ongoing labor shortage in the U.S. can have a detrimental impact on quality and accuracy, affecting members’ experiences and the plans’ bottom line.
Challenge
A leading Medicare Advantage health plan faced significant attrition. This made it challenging to staff healthcare claims work domestically and led to:
- Financial inaccuracies
- Performance quality issues
- Steep training costs
Solution
The ResultsCX team deployed a high-performing and fully engaged offshore team that was cost-effective and quality-focused:
- Instituted a more professional hiring profile for claims adjudication team, requiring payer claims knowledge and demonstrated financial acumen
- Offered premium pay to incentivize staff
- Created a career path for tenured agents
- Fostered the cultural view of the team as an elite staff
Results
Within 60 days, client satisfaction increased significantly, linked to cost-effective performance and outstanding service quality.
- Consistently achieved close to 100% financial accuracy
- Regularly attained service quality scores above goal
- Reduced annualized attrition to 18%, far lower than U.S. domestic rates
- Ensured 3.5 years is average agent tenure
