AI driven Compliance automation for a Large Health Care Organization
Overview.
A leading vision care administrator with 39+ million members across Medicare, Medicaid, and Commercial lines of business lacked industry best practices and was becoming uncompetitive.
Challenges.
The administrator needed help in multiple areas:
Lack of industry best practices across operations management and customer service.
High dissatisfaction with providers and members.
Consistently non-compliant with CMS regulations.
Missed contractual SLAs with Health Plans.
Outdated technology stack with no automation.
Solution.
Coforge came up with a multi-step roadmap for the client:
Implemented a platform for best-in-class Member/ Provider Experience including AI driven automation for Compliance management.
Re-engineered and streamlined traditional processes and workflows to align with new platform.
Augmented staffing solutions consisting of domain experts in Member Services, Appeals & Grievances and Provider Disputes.
Provided ability to prepare for audits and proactively manage potential NONC issues.
The Impact.
47%
Reduction in Total Cost of Ownership
28%
Reduction in headcount
15,000
Backlogged cases were resolved
Bring us your challenge.
Let’s Coforge your next success story.
Your browser does not support the video tag.
WHAT WE DO.
Explore our wide gamut of digital transformation capabilities and our work across industries.
Explore
