Customer :Our client is a major Financial Services and Health Insurance player in the USA catering to insurance and wealth management businesses providing a range of advisory and brokerage services to the its clients. They serve corporate and high net worth individual clients throughout the United States and in Canada, with a focus on the middle market and entrepreneurs. They are committed to provide best healthcare to its members and enhance the competitiveness of companies.
Business Problem :The client had a many fold rise in their new enrolments contributed by their expansion mission into other US states and to further enhance on it and stabilize upon their business growth, they needed an electronic billing system that is robust in terms of operating efficiency, capabilities to support their customers via multiple channels, architectural competency for a robust and scalable payment related procedures like invoicing, updates & transactions and still able to bring down cost with end to end business critical engagements support.
Challenges: - The focus was to create a sophisticated premium billing system touching almost all the aspects of insurance exchange and complying with the regulatory requirements of the Affordable Care Act. To support billing & invoice accuracy the challenge was to process the precise information related to subscribers personal and payment data and other factors in a business constraint situation which was prone to vary at different times in a transaction cycle.
All of these difficulties needed a software that simplifies, centralizes data entry and management with inherent integrated features likes of Electronic Remittances, Pre-Billing Claim Checks, Claim Scrubber Edits, Contract Management, scanning and that facilitates to deliver targeted communication.
The Gunaatita Edge: - We completely revamped their existing software into a world-class premium billing system that resulted in auto-adjudication rate improvement by double digits while providing volume scalability and operational cost savings. Below are highlights.