Overview:

Process Redesign and Technology Enablement for a paperless enrollment and underwriting workflow for a Large, East Coast Healthcare Payer

Business Issue:

A backlog of applications resulted in 18% of all applications being delayed during a Medicare Advantage open enrollment, as there was no system in place to track and trace applications throughout the enrollment process. Membership applications would get misplaced and fail to be entered into the system for CMS approval. The problem created unsatisfied customers and overtime for staff members.

Engaged to review the current Med Advantage process, technology, and organization structure to identify root cause issues and develop and implement a repeatable process that could track and trace applications and eliminate root cause issues caused by Agents and the enrollment team.