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| Home » Claims Analysis and Audit Case Studies |
Claims Analysis and Audit Case Studies |
| Case Study - 1 |
Claims Analysis and Audit – A KPO Process |
| Industry : |
Claims Analysis and Audit |
| The Client : |
The Client is a leading Cost Containment Company based in (Nashville) Tennessee. |
| The Challenge: |
- Exponential Business growth
- Volume flow is highly unpredictable
- Lack of resources
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| The Engagement: |
The current engagement is in the Data Mining business, with InfiniteBPO providing Claims Audit & Analysis. The process involves Claim review, analysis, research & Provider contact. The engagement would entail InfiniteBPO to perform the Claims Audit function & allied services, from its premises in India. |
| The Solution: |
- We offered an offshore delivery model for meeting the Claims Audit and Analysis
- We provided flexible staffing models to be able to absorb the fluctuation in volumes and deliver higher refunds than experienced onsite analysts.
- Established effective process methodology to increase refunds in line with six-sigma practice in a short span of time.
- Designed a KM Tool to realize higher refunds & quality with the implementation of DMAIC methodology.
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| The Results: |
- Offshore team started with 10 resources and has grown to 21 resources
- Provided cost savings in excess of 50 %
- Delivered services at accuracy levels greater than 99.5 %
- Team identifying in excess of 2Mn USD every month as contractual over payments made by leading insurance companies.
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