A Leading Health Insurer Improves Claims Performance and Saves Millions

Challenge

A leading US health insurer was struggling to keep its health insurance products affordable and identified claims processing errors and inefficiencies as an area where it could save millions of dollars. Due to processor errors, provider submission errors and other controllable factors, claims were being incorrectly rejected or incorrectly paid in an estimated 5-10% of claims, costing the insurer and its providers over $14 million a year in administrative costs to resolve.

Solution

The company selected the Enkata Claims Performance Business Solution to equip its claims supervisors, analysts and provider network managers with a system to reduce claims errors. The Enkata Solution works by aggregating and analyzing data from its multiple processing sites and then identifying the factors leading to claims processing rework and overpayments.

The system identifies where in the process the error was generated, whether by agent error, incorrect provider claim submission or policy/procedure, so that the manager of the employee or process can effectively correct the problem.

Learn more about Enkata industry specific solutions for Health Insurance