CASE STUDY
Industry:
Health Insurance
Products / Services:
AEP Support
Zero-Delay in processing applications and fulfilling SLAs during AEP
Client Background
The customer aims to provide high-quality, affordable, and integrated health care solutions to its members and communities. In addition to Medicare Advantage, the company offers commercial group products, individual and family health plans, employee assistance plans and Medicaid plans.
Client Requirements
The customer faced challenges during AEP that required careful planning and collaboration. With the previous service provider not able to meet the required SLAs, the client was looking for a partner who can ramp-up the team within a short notice and provide a smooth AEP with great member experience.
Over 98% correspondence compliance during AEP
Quick ramp-up of domain team handling large influx of applications
Automated workflow based system for swift application processing and support
Service Highlights
With the high expectation of meeting SLAs and incredible member experience during AEP, Wipro ramped-up the domain team within a short notice and ensured timely processing of augmented application inflow. OEV call support was provided for enhanced member experience.
Domain Expertise
Provided well trained and seasoned team for task management including LEP reviews and reconciliation.
Correspondence
Seamlessly managed surged
letters/correspondence -
Approval, Denial, OEV, LIS, LEP, etc.
SLA
Met SLA compliance despite huge volume of applications during AEP, all applications processed within 24 hours.
Workflow
Enabled automated task allocation for improving efficiency of back-office support executives.
Compliance
Met CMS compliance with respect to enrollment, TRR management and membership maintenance.
Governance
Established daily, weekly and monthly governance process for project status and updates.