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HEALTHCARE

Higher Healthcare Plan Volumes, Lower Performance Guarantee Payouts

The Challenge

Each year, U.S. health insurance companies provision millions of dollars in anticipation of health plan inaccuracies and legal penalties. To deliver accurate health benefits and minimize legal payouts, insurers must ensure their systems are ready for business at the start of the new year.  

A leading U.S.-based retail pharmacy and pharmacy benefits manager faced high payouts every year due to erroneous claims. The company wanted to raise the bar on the customer experience with improved patient-centric care and more accurate claims administration.

Our Approach

Cognizant modernized the company’s benefit plan rollouts using BenefitSERV, our Intelligent Product for platform-based benefits configuration and automated validation. We improved the customer experience with a three-pronged strategy: pharma experts who focus on the end user; accurate coding of benefits plans; and end-to-end automation of the validation process.

More Flexible, Accurate and Competitive Health Plans

With Cognizant’s end-to-end approach to quality assurance (QA) the company achieves both a many-fold increase in plan volumes and 100 percent compliance with its “plan active by date” targets. Our solution improves plan accuracy to 99.5 percent, helping the company reap significant savings in payouts—and increase its bottom line. Better plan accuracy also translates to member satisfaction.

50%

reduction in go-live timeline for healthcare benefits plans

30%

reduction in QA costs

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