This Is What Success Looks Like…

Last week I had an opportunity to present alongside Sally Miller (VP of Operations at CareFirst) at the Healthcare Claims & Services Conference in Las Vegas.

The basis of the presentation was to review how CareFirst is continuously improving claims operation through the usage of analytics and automation (robots). While I can’t publically detail CareFirst’s outcomes, I will say the results they are receiving are very impressive. From a broad perspective, my observation is that CareFirst has taken action in three key areas that are leading them to exponential operational improvements.

Organizational Alignment

Sally and team are aligned to identify and execute operational improvements. Utilizing OpenConnect analytics, a team evaluates and prioritizes high ROI automation projects.

This team then documents the requirements and hands off to the robot scripting team. Then an operation team pushes the robots into production. This conviction to continue process improvement allows CareFirst to maximize investment in technology and people with a high rate of return.

Focus on high value automation

Once edit codes have been ranked, the teams focus on requirements and execution on the edit codes that will increase First Pass Rates (auto-adjudication). Using this value-lens, CareFirst operations can utilize robots to guide organizational improvement across the enterprise, and ultimately deliver both financial and service-level results back to their members and providers.

Not a single platform

Many payers only consider automation within their core system. However, the CareFirst team utilizes multi-platform robotic process automation to solve enterprise-wide challenges. This approach has led them into automation that includes mainframe, web services, and other types of platforms. They are currently working to automate new opportunities such as cash receipts, member/physician look up from third party applications, and other Blue Association applications.

We appreciate CareFirst as a customer utilizing OpenConnect solutions for analytics and automation. I for one am very impressed with their organizational approach for business improvement. Well done!

Analytics for Insurance Summit

OpenConnect CEO Dr. Edward Peters to Discuss the Potential of Technology and Data Capture at the Analytics for Insurance Conference

Dr. Peters will be featured in a session at the Analytics for Insurance Conference titled “Understand how analytics is changing claims handling and underwriting”

Dallas, TX, March 20, 2015 – OpenConnect, a leader in operational intelligence and workforce analytics software, today announced that CEO Dr. Edward M.L. Peters will be a featured speaker and panelist at the Analytics for Insurance Conference on March 25-26 in Chicago. Dr. Peters will focus on how technology and analytics can make claims handling more efficient and transparent.

The claims handling process involves massive amounts of data, but unfortunately much of this data has historically not been able to be tracked and measured in a meaningful way. Emerging technologies and the use of analytics that are capable of tracking this data can enable a new age of innovation and improvement in the claims handling process.

This session will look at a number of key areas in which automated processes and analysis can improve the claims process – in detecting fraud, reducing costs and creating real-time and actionable data. Dr. Peters will focus on how to identify and utilize previously un-captured data in ways the industry has not seen before. The ability to capture this data creates valuable and actionable analysis that can lead to greater efficiencies.

“In the claims process, only a small portion of the data are readily available for analysis, with a large portion going un-captured and therefore unavailable to analytical efforts,” said Dr. Edward Peters, Chief Executive Officer, OpenConnect. “‘Dark Events’ are discrete actions that affect the state of claims and normally go un-captured and un-recorded by most claims processing and analysis systems.  It is through the discovery, capture and analysis of ‘Dark Events’ that major improvements can be uncovered and realized.”

The Analytics for Insurance Conference takes place March 25-26 at the Hilton Chicago/Magnificent Mile Suites in Chicago, IL. Dr. Peters will speak on March 25th from 4:30pm – 6:00pm.

 

Media Contact

Tracy Donalson
Weber Shandwick, for OpenConnect
469-375-0236
tdonalson@webershandwick.com

Recorded Webinar — Improve Claims Processing Through Workforce Analytics

Webinar hosted by AHIP and WorkiQ recorded on December 9, 2014, featuring Molina Healthcare

Using technology to empower efficient claims processing

WorkiQ measures the activities of your back office team in real-time. With this data you can be proactive in re-capturing non-productive time and increase productivity in the process.

Molina Healthcare will discuss their experience using technology to support and improve claims operations. Areas such as process improvement, employee performance score carding and employee efficiency can all be directly impacted if the right technology is implemented.

Discussion topics include:

  • Electronic time motion study
  • Measuring claims examiners based on standards
  • Comparing claims examiners to their peers
  • Comparing time spent in productive activities that drive engagement

This webinar will explore emerging best practices using big data in capturing and measuring back office productivity. Armed with accurate and real time data, this webinar will also discuss a best practices approach to systematically improve back office operations through coaching, employee engagement strategies, and improving overall team productivity to breakthrough levels.

What you will learn by attending:

  • How providing visibility through real time collection, measurement and on-going monitoring can impact productivity in claims operations
  • Reporting and dashboard strategies to effectively improve employee engagement
  • The power of an engaged workforce with an active voice in the productivity measurement approach and interpretation

Click here to see the recorded webinar.