Case Study

Offshore Managed Medicare Claims Work Achieves Near 100% Accuracy

2 months ago

For health plans, efficient and effective back-office operations are crucial to success. Staffing issues like the ongoing labor shortage in the U.S. can have a detrimental impact on quality and accuracy, affecting members’ experiences and the plans’ bottom line. 

The Challenge 

A leading Medicare Advantage health plan faced significant attrition. This made it challenging to staff healthcare claims work domestically and led to: 

  • Financial inaccuracies 
  • Performance quality issues
  • Steep training costs 

The Solution 

The ResultsCX team deployed a high-performing and fully engaged offshore team that was cost-effective and quality-focused: 

  • Instituted a more professional hiring profile for claims adjudication team, requiring  payer claims knowledge and demonstrated financial acumen 
  • Offered premium pay to incentivize staff
  • Created a career path for tenured agents 
  • Fostered the cultural view of the team as an elite staff 

The Results 

Within 60 days, client satisfaction increased significantly, linked to cost-effective performance and outstanding service quality.

  • Consistently achieved close to 100% financial accuracy
  • Regularly attained service quality scores above goal 
  • Reduced annualized attrition to 18%, far lower than U.S. domestic rates 
  • 3.5 years current average agent tenure