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.