The level of care that your claims organization provides is an integral part of your overall product delivery. Now more than ever with all aspects of reform—including the looming individual mandate—your members are demanding great service, particularly at the time of a claim when they are hoping for a quick, painless resolution to a stressful situation. Therefore, it is critical for member satisfaction and ultimately, your ongoing success, to deliver exceptional service throughout the claims experience.
Getting Out of the Starting Gate
The key to delivering exemplary claims care rests in quickly and accurately responding to claims inquiries. In order to do so, your claims representatives must be able to get their hands on the information they need to answer questions and resolve issues fast and accurately. But access to information is only half of the battle. With statistics showing that nearly half of all member interactions are accomplished via documents, it is clear that representatives also need access to tools to help them communicate that information to members. And those tools must be able to generate communications in real time and deliver them in any method preferred by each individual member—print/mail, fax or email.
Becoming a Pacesetter
The challenge for most claims organizations lies in implementing technology solutions to simplify the complexities of gathering information and producing timely, accurate and relevant communications. While it sounds easy enough, most health plans struggle with ways to manage information produced by a host of systems and spread across enrollment, core administration and claims management systems, so that it may be accessed by non-technical claims representatives when they need it.
Simplifying this level of complexity requires comprehensive member-communications applications designed specifically for a health plan’s claims organizations. These are the exact applications that have been helping WPS Health Insurance—the largest TRICARE claims processor that “set the pace” in improving claims response by achieving a 98 percent customer-satisfaction rate while processing over 65.9 million claims for more than two-million beneficiaries.
Reaching the Finish Line
By leveraging its modern member-communications system, WPS Health increased the efficiency of its claims-management process and empowered employees to deliver better claims experiences to its customers. By reducing the average time to process an inquiry from 6 ½ minutes to five minutes, streamlining processing of outbound communications to a 90 percent same-day turnaround and improving accuracy levels of communication with members, WPS Health is “reaching for the finish line” in the race to improve claims response.
Click here to learn more about how WPS Health is winning the member-experience race with improved claims response.