Transforming Insurance Back Office Support and Claims Processing for a Leading Insurer

Client

The client is a leading provider of health insurance, life insurance, voluntary benefits, and benefits management services, operating a vast insurance back office support system. With a presence across the USA, the company has been serving millions of customers for over a century, specializing in benefits administration for both fully insured and self-funded employers.

Challenge

To modernize their claims processing system, the client sought to overhaul inefficient workflows and introduce advanced technologies to enhance accuracy and scalability. The primary objectives included reducing operational inefficiencies, eliminating manual errors and ensuring seamless claims processing, especially during peak volumes.

Key operational challenges included:

• Managing fluctuating claim volumes while maintaining high accuracy and fraud prevention.
• Handling both structured and non-formatted claims efficiently.
• Addressing cost pressures in a highly competitive market.
• Enhancing operational efficiency and reporting to gain actionable business insights.
• Strengthening documentation and workflow processes to support change management.

The client needed a flexible, scalable partner to support end-to-end claims operations while reducing total cost of ownership. The goal was to implement a technology-driven solution to streamline claims processing and ensure future business scalability.

Solution

Hexaware implemented a state-of-the-art people-process-technology solution to transition the client’s claims processing services with zero business disruption. The transformation included an end-to-end solution covering mailroom services, storage and retrieval, digital imaging, data entry, pre-adjudication, and adjudication.

Key elements of the solution included:

• Hexaware workflow engine with OCR integrated functionalities to automate data processing.
• Workflow control & audit tool for real-time production metrics and a flexible quality assurance framework.
• Creative training methodology to shorten the transition timelines and optimize knowledge transfer through an offshore shadow team.
• Six Sigma methodologies, including Root Cause Analysis and Pareto Analysis, to enhance operational controls and efficiency.

By leveraging advanced automation and analytics, Hexaware significantly improved the client’s claims processing efficiency, accuracy, and scalability.

Benefits

Hexaware’s solution delivered significant improvements in efficiency, accuracy, and cost savings for the client’s insurance back office support operations:

• 30% reduction in total cost of operations
• 99% accuracy in claims processing, surpassing the expected 95%

Reduced dependency on client availability with the automated transmission system led to faster end-to-end processing times.

• 20-25% higher productivity and efficiency, with benefits directly passed on to the client.
• Reduced transition timelines, by 5 weeks for simple processes and 7 weeks for complex processes.

Summary

Hexaware transformed the client’s insurance back-office support with a cutting-edge people-process-technology solution, enhancing claims processing efficiency, accuracy, and scalability. By implementing automation, advanced analytics, and Six Sigma methodologies, Hexaware reduced operational costs by 30%, improved accuracy to 99%, and achieved significant productivity gains, driving business growth and compliance.