Process Improvement and ImplementationCase Study
A large regional health insurer servicing over 3 million members was not meeting key performance targets.
The insurer was not meeting its key performance targets in the customer service, claims, and correspondence areas including:
- Inquiry Timeliness
- Inquiry Accuracy
- Average Speed to Answer
- Abandonment Rate
- Claims Timeliness
- Claims Accuracy
Zelus worked with the insurer to determine the root cause of the issues and implemented customized solutions including:
- Designed and implemented workflow improvements resulting in removing 4 days from the claims cycle.
- Designed and implemented a comprehensive skills assessment for all areas.
- Developed a comprehensive Customer Service Training Program.
- Developed a comprehensive Claims Training Program.
- Developed a comprehensive Correspondence Training Program.
- Assisted struggling trainers by delivering components of the training as needed, often with little to no notice.
- Evaluated team leader and manager capabilities via Zelus-developed calibration process and developed coaching program that upgraded leadership skills significantly.
- Improved performance score results by 17% in six months.
- Improved performance score results by an additional 23% in the next 12 months.
- Performance score improvement earned the client significant incentive dollars.
- Improvements led to national recognition for the insurer.