Reducing Pending Claims Via Lean Six Sigma
Health Insurance Project Overview
22% reduction in pending claims and $366,236 in savings.
Six Sigma DMAIC
A large health insurance carrier was receiving approximately 22,000 claims per day, totaling approximately 5.5 million per year in their Maine office. Fifteen to twenty percent of the daily claims (roughly 3,800) required manual intervention to adjudicate, meaning they were “pending.” Each time a claim was pended, it required extra handling, at an average cost of $2.00 per claim.
The insurance provider could not expect to entirely eliminate pends. Some claims are automatically sent to a manual process, because they require special handling, for example, if they require a medical review.
By improving the current process, this insurance provider would reduce the number of claims pended daily, thereby reducing the number of claims that were being backlogged. Customer and provider satisfaction would increase due to this more timely process.
The project goal was to reduce the number of claims pended each day by 20%, resulting in monthly savings of approximately $30,000, equaling roughly $360,000 per year. To achieve this, the company reviewed exactly what was making a claim “pend” and how they could improve the system flow. They hoped to increase customer satisfaction, decrease their administration costs, and put a faster, more accurate, and seamless claim process in place.
Working with Juran, this insurance carrier identified and fixed 27 system issues, achieving a 22% reduction in daily pends and a savings of $366,236 in 7 months. The Maine office’s pends are expected to continue to decrease, resulting in annual savings of almost $900,000. The team also was able to foster interdepartmental and interstate relationships, the value of which is priceless.
The insurance carrier was able to successfully reduce the number of daily pends, and add a significant amount in savings to their bottom line.
Transform Your Business
Get in touch with us for more information on how we can help your organization attain sustainable results, and start your journey towards world class quality.