After processing all healthcare claims in-house, this client made the decision to outsource benefits administration to a large national commercial administrator. From the start, one of the client’s key concerns was how to best validate the claim payment accuracy of the outsourced administrator. Since this client utilizes a Six Sigma management strategy throughout its organization, it was critical that the outsourced benefit process is measured in a way that complemented and supported the Six Sigma process review approach.
As in any business, there was also a concern to identify any wasted dollars from overpayments, and to create forward going savings as quickly as possible. At the time of the transition, there were nearly 50 individual plans to be administered, all with varying benefits. Additionally, the client owned a network in its main geographic area of business and required the administrator to adhere to their pre-negotiated pricing schedule for that area.