Case Study

Reduced turnaround times, increased quality scores for claims processing.

One of the oldest self-governing British overseas territories located in the North Atlantic Ocean.

         

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Industry
Healthcare
Services
Digital Transformation
Business Process Transformation

The Problem

Our client administers a government health insurance program that combines government healthcare insurance and approved private health insurance carriers. The client was challenged by years of poor funding and was using outdated, manual claims adjudication processes that in some cases were taking three years to fully investigate, approve, and make payments to providers. No formal business rules or process documentation was in place as the department was understaffed, lacked any capital for innovation or improvements, and additional resources were costly.

The Sutherland Transformation

Sutherland brought in its team of health plan administration subject matter experts (SMEs) to perform a rigorous discovery and analysis session. This helped to refine requirements, produced gap analysis reports, and created initial configuration/customization specifications. Based on the defined requirements, Sutherland decided to implement a well-known administration platform. We then transformed the platform’s core functionality by building in our proprietary IT capabilities and services to optimize claims processing, premium billing, enrollment, eligibility, and reporting to the client’s specific needs. Once all this was in place, our SMEs then re-engineered all workflow processes onsite with the client’s staff and began providing hands-on consulting and training for the team so they could better handle and understand the new way of doing business.

Some partnerships are meant to simply lower costs, but Sutherland crafted an end-to-end solution to revamp processes, improve technology, and empower the current staff so its operations—and citizens—remain healthy for the long-term.

The Results

With the combination of new processes, technology, and a more empowered client staff, Sutherland was able to dramatically improve the turnaround time and quality scores for claims processing. The average turnaround time was decreased from a few months to roughly ten days.

100% Sutherland now touches the claims for 100% of the territory's population

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