Improving manual claims processing

© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL

Insight. Action. Results.

Improving Claims Processing

Using Enkata to Improve Manual Claims Processing

1

© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL2

> Productivity Isn’t Where It Needs to Be > Skill and training gaps> Work habits> Process and technology issues> Surveys show manually adjudicated claims cost more than $6 each

> Accuracy Isn’t Where It Needs to Be> Error rates on poor processors may be >10%> Underpayments = complaints and rework> Overpayments = lost money, and few are caught

Claims Payers Have Two Problems


> Managers have limited visibility into how claims processors work> What their work habits are> Where they are struggling> If targets are set correctly

> Employees have limited visibility into how to work> What is the best process for a claim type> What are the tricks the best people use to be productive> “Am I doing this right?”

The Root of Problem: Lack of Visibility


> “Managing by Metrics” Isn’t Managing> “Claims per Hour” doesn’t tell you if they are following the right

process> Just knowing the metric gives no insight into how to improve

performance. > If metrics are compared to past average instead of potential

performance, you’re capping your potential at average.

High Level Metrics Don’t Help


> “At a Glance” understanding of claims processors> How they work> What drives quality and productivity> What specific actions can help them improve

> Process Analytics for Claims Payers> What steps lead to higher quality?> Which steps are people skipping?> Have the best people figured out a better way to do things?> What mistakes are most common?

Enkata’s Solution Starts with Visibility


> More Granular Data> Views from Month-to-Month performance down to the specific

steps taken to process every single claim

> Easiest to Understand> At-a-Glance reports tell managers and processors everything

they need to know to understand performance

> Flexible Analytics for Data Scientists> Enkata captures and creates data about claims processing, and

then provides a free form analytics environment that lets data scientists explore the data, find deep insights, and understand everything about manual claims processing

Enkata’s Solution for Claims Payers is Completely Different


> Identify and Eliminate the Behaviors that Lead to Errors> Enkata delivers understanding into error prone workplace

behaviors including target shooting, multi-tasking, thrashing and excess pending

> Identify and Enforce Process> Processors may be skipping the annoying steps that keep

accuracy high. With Enkata, you can see who is taking short cuts, and tie that to the accuracy issues you’re trying to fix.

> Identify Exactly Where People Need Help> Even generally good processors may have issues or make

mistakes with certain types of claims. With the visibility delivered by Enkata, managers can see where people struggle and need extra coaching

Enkata Improves Claims Accuracy


> Eliminate the behaviors that lower productivity> Excess email and IM, idle time and black list internet, and other

behaviors that detract from production

> Eliminate the Problems that Hold People Back> Employee skill gaps, technical bottlenecks, incorrect training

> Set Targets Based on Potential, Not Historical> Most claims payers set productivity targets based on productivity

levels they’ve seen in the past, not on what an individual should be expected to produce in a time period.

> Replicate the Best Practices of Top Performers Across the Group

Enkata Improves Claims Payer Productivity


> Map Different Practices to Understand How Different Groups of Workers Perform> Discover best practices> Have data based discussions about claims processing

> Track the Key Steps Required for Accuracy> Who is skipping them? > Who is doing them out of order?> What is the impact of non-compliance?

Enkata Improves Processing Compliance


Visit our Website

www.enkata.com

See a Demo

[email protected]

Enkata can help you

http://www.enkata.com/

Improving manual claims processing

Technology

Transcript of Improving manual claims processing