Claims processing optimized, operations transformed, goals achieved

What We Did

A large dental benefits provider was looking for the right partner as it united its government and commercial business units. The transformation initiative called for replacing two claims processing systems with one—and ensuring the new technologies aligned with business operations, in order to increase member self-service capabilities and position the company for growth.

Our multidisciplinary team worked in five phases over two years to launch the new procedures and platform for 10+ million members.

The Challenge

A leading dental payer in the middle of a critical transformation came to us with a challenge: how to bring together two separate business units with two separate claims processing systems, quickly and seamlessly.

The goal? Building a platform that would drive efficiency and growth, elevate the brand, and position them for future mergers or acquisitions. The timeline? Fast.

It would take a team with multidisciplinary expertise in the healthcare industry to optimize operations, deploy technology, manage change, and implement systems to bring this change about—all in just two years.

That’s where we came in.

An Undeniable Approach

Our wide range of expertise in technology, specifically in healthcare settings, was critical in helping the client build a strategic plan for bringing a comprehensive claims platform to life.

Together with the client, we decided that the aggressive two-year timeframe called for leveraging the new system’s native functionality whenever possible—and employing system enhancements only as a last resort. It also called for an agile and flexible approach, for which our teams are purpose-built.

We completed the work in five phases. Each step of the way, we made sure that technology, business, and industry experts were working together to meet the client’s objectives:

• Phase 1 began with an exercise to capture current-state and target future-state business processes and deepen our understanding
• In Phase 2 we tested the requirements in the new system to identify gaps. Technology and business should work seamlessly together, so where the two didn’t align, we worked with business owners to determine the best course: modify the system or adapt the processes
• In Phase 3, we implemented solutions, developing core claims system changes that were needed to sustain business operations
• We validated the business model in Phase 4 to ensure the system would process claims effectively when it went live.
• In the final phase, we worked alongside the client team to launch the new procedures and implement the new claims platform for more than 10 million members.

To support the transformation, we established a program management office to guide project resources, communications, timelines, and reporting to key stakeholders. And we oversaw organizational change management—vital to driving internal and external engagement.

Returns You Can Measure

Claims processing, optimized. Operations, transformed. All in two years.

The client saw a 40% reduction in core business processes through standardization. With the new system in place, 1.2 million claims and prior authorizations are processed each month.

The client also reduced headcount through digital advances; drove efficiency by improving claim turnaround time, transaction throughput, and scalability; and achieved paperless workflow for claims processing.

The dental insurer was now positioned for future growth and acquisition. Goals, achieved.