CASE STUDY
Industry:
Health Insurance
Products / Services:
Member360, Revenue360
Modernization of a leading BCBS Health Plan
Client Background
The client is a prominent BCBS plan aiming to improve the well being of the community by promoting better health outcomes. They collectively manages over 1.5 million members across Individual, Sponsored and Medicare plans.
Client Requirements
The client was looking for an end-to-end member management system with premium billing and revenue reconciliation modules. As the onboarding and member maintenance processes were outdated, a complete modernization was required to ensure compliance with CMS standards.
Engagement Highlights
90%
Increase in Operational efficiency in member enrollment
25+
Percent Reduced Operational Costs
98%
CMS Acceptance Rate
Solution Highlights
Our solution modernized the existing system and helped the customer to improve operational efficiency and minimize operational costs. The implementation of this solution automated the overall process and ensured compliance with CMS standards.
Easy
Onboarding
Easy Member onboarding through eligibility check and enrollment. Real-time API eligibility validation with CMS
Financial
Reconciliation
Fully automated reconciliation of CMS Beneficiary enrollment & payment data ensuring maintenance of proper individual ledger accounts.
Premium
Billing
Provided end-to-end membership billing management with effective LIS and LEP process
Actionable
Analytics
Enabled generation of Universe reporting from different source of truth to ensure timely submission to CMS
CMS
Compliance
Maintain 100% regulatory compliance and deadlines by preconfigured workflows and automated notifications