Challenge

A leading U.S. Health plan current environment required onshore nurses to support the Utilization process by handling inbound calls for to pre-certification related inquiries from providers and members. 

Numerous steps involved in the existing process made it complicated and highly inefficient, requiring contact center nurses to manage calls using multiple internal systems and screens, there by affecting the case accuracy.

Human Ingenuity in Action

The client partnered with EXL Health to transform their UM telephonic contact center through digital innovations and technologies.  

EXL Health analyzed the current contact center UM process and identified significant opportunities to increase process efficiency by creating a process guidance workflow. The workflow was a newer user interface tool designed to help nurses manage case workflows. It also featured automated documentation which replaced their free-hand documentation approach. 

Outcomes

The client was able to reduce average handling times and errors in documentation, improve the process through automation and template creation and establish a single application for quick references of commonly used resources.

Moreover, the client saw a 4-6% improvement in UM average handling tome and realized over $60,ooo in annualized savings.