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Performance Improvement
Improving
performance in key payer operational functions such as claims
processing, customer service, and membership and billing is critical
to achieving and maintaining customer satisfaction. Favorable
customer experiences are a key differentiator for customer retention
and satisfaction which also promotes positive marketing for
prospective customers.
CTG’s performance improvement solutions for healthcare payers
combine industry and technology expertise to drive operational
efficiencies and administrative cost reductions while improving
customer service and satisfaction. By defining performance goals and
evaluating current processes and customer satisfaction data, CTG
benchmarks performance, identifies gaps and opportunities, and
recommends customer-aligned metrics and process improvements. We
then design and implement a fully integrated client-specific program
to improve performance in key payer operational functions. Clients
benefit from our independent assessment, unique solutions, and
practical implementation support that lower costs, improve overall
quality, and move payers toward best practices.
Client Benefits: CTG Operational Performance
Scorecard
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Current
(Transactional) |
Future
(Aligned with customer expectations) |
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Enrollment |
· Member
enrollment accuracy
· Group
enrollment accuracy
· Enrollment
timeliness |
· Average
days to process member
· Average
days to ID card fulfillment
· %
of membership files processed accurately
· %
of ID cards issued before effective date
· Administrative
cost per member |
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Inquiries |
·
Inquiry accuracy
· Inquiry
timeliness |
· Average
handle time
· First
contact resolution
· %
per channel
· Ratio
of inquiries to members
· %
of handoffs/transfers |
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Claims |
· Claims
frequency
· Claims
accuracy
· Claims
timeliness |
· First
pass rate
· Average
processing days
· %
of adjustments
· Administrative
costs |
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Telephone |
· Blockage
rate
· Abandoned
rate |
· Average
handle time
· Average
speed of answer
· Average
wait time
· Average
hold time |
· Web
response time
· Web
availability
· Transaction
fail rate
· Wait
time for agent |
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Copyright CTG, 2010. All rights reserved.
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Ontology