Process Improvement and Implementation

Case 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.