Challenge

A large national health plan needed a partner to support Other Party Liability (OPL) programs. The need was across lines of business and acquired entities, requiring various models of support.

The challenges faced by the client included:

  • Considering and addressing the various needs and requirements across lines of business.
  • The required staffing support for in-house department OPL processes and the growing case volumes.
  • The need for predictive analytics to refine case identification, direct where to focus resources, and how to prioritize cases.
  • Enhanced reporting needs and flexibility.

Human Ingenuity at Work

EXL Health’s Subrogation solution, part of the company’s Payment Integrity Services, addressed the client’s challenges and concerns with its advanced analytics and subrogation expertise to prioritize cases and allocate resources accordingly. EXL Health’s approach was to:

Outcomes

 

 

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