Large Dental Plan | Healthcare & Life Sciences, Technology

A modern claims platform cuts talk time 18%, delivers immediate progress toward a digital future

A modern claims platform cuts talk time 18%, delivers immediate progress toward a digital future

Our Impact

A dental benefits administrator recognized that the key to differentiating itself in an increasingly competitive market was to be digital. That meant modernizing the heart of its operations—its claims technology platform. Doing so would unlock significant benefits: operational efficiencies, better stakeholder experiences, and enhanced analytics and reporting, including access to self-service capabilities. The company estimated that the platform upgrade would deliver more than $5 million in financial value over five years.  

When the company sought an experienced partner to support it through this change, it looked to West Monroe. Our relationship with its network extends nearly a decade—and our track record for modernizing dental and health payer platforms goes back even further. We helped the organization identify the right digital claims technology for its needs, design the future platform, and bring it to fruition—all in just 24 months. Now, the impact is adding up. 


Less talk time in the customer call center


Fewer manually processed claims


Claims paid the next day

The Full Story 

The Challenge

The client’s aging claims operations platform was expensive and difficult to maintain and update. The organization wanted to move to a modern, new digital platform that would enable growth while reducing operational costs. 

Executives were eager to complete this critical step in the company’s digital journey. But platform transformation is a complex undertaking involving all of the organization’s stakeholders—including employees, dental providers, brokers, and plan members—and requires experienced guidance to maintain momentum. That’s where West Monroe came in. 

An Undeniably Different Approach

We assembled a team with significant dental and health plan platform experience—inside and outside the client’s network—and came to the table with an objective mindset to ensure the best solution for the company. We used a proven platform selection methodology focused on unique business requirements and tangible value—an approach that enabled the company to move forward with confidence in its decision. Based on our analysis and recommendation, the client chose to implement a claims platform developed by another member of its network. 

A critical aspect of our approach to being digital?   A simultaneous focus on technology and operations.  Our multidisciplinary team—with expertise in dental plan operations, cybersecurity, change management, and complex program management—not only delivered a working technology platform but also made sure the organization was ready to use it to its full potential to achieve efficiency, experience, and other goals. That’s what being digital looks like. 

Our experience and approach led to delivering the new platform within two years. The client reached an 80% adjudication rate on the new platform within two weeks of launch. Within one month of go-live, it received more than 4,000 provider claims through the portal and consolidated more than 30,000 individual subscribers on the platform.  

Project Timeline

Define system requirements; Conduct system demonstrations; Prepare cost-benefit analysis; Select platform
Define business rules; Map, clean up, convert, and validate data; Develop, configure and test systems
Re-engineer processes; Deliver training, communication, and change management; Integrate and test systems
Plan the cutover; Support the system launch; Provide post-conversion support

Real Results

The company completed a key step in its digital journey with significantly enhanced analytics, visualization, and reporting capabilities, employees and executives can assess operations and make better, timelier decisions. 

The organization also realized almost immediate efficiency improvements and cost reductions: It has cut call center customer talk time by 18% and reduced manual claims processing by 10%, helping build momentum toward its five-year goal of more than $5 million in financial benefit.  

The platform’s ability to process new markets opens up new opportunities for growth. Meanwhile, the change has transformed experiences for users inside and outside of the organization. For example, modern portals and digital channels provide more sales and access capabilities for brokers and employer groups. And both members and providers benefit from improved time to payment—with 92% of claims paid the next day. 

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