The Client

Our client is a national association of service corporations, all of which receive funding through government grants. It provides health insurance to 3,500 volunteers, totaling approximately $9 million in premium costs annually.

The Challenge

Many of the client’s volunteers who receive coverage, rotate on and off the health plan on a monthly basis, making administration time and labor intensive. Our client lacked the support needed for claims processing and interaction with their carrier. In addition, they needed Affordable Health Care Act (ACA) compliant plans, however, the costs for minimum coverage ACA compliant plans were no longer affordable.

The Solution and Result

Our first order of business was to implement specific processes for front end claims administration for the more than 500 groups that had people that came on and off plans each month. We also provided day to day support through a dedicated, four-person full-time team who delivered high levels of service and expert advice. This included developing and reporting on key performance metrics such as tracking which groups were on or off coverage, losses incurred, turnaround time for claims, call answer times and call hold times, amongst others. As a result, we were able to help them renew coverage at a cost that was significantly below trend.