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Healthcare

TriZetto Enrollment Solution Helps Health Plan Process Applications Faster


The Challenge

As SelectHealth® began expanding its coverage, the health plan realized that its existing systems could not efficiently handle the new demands. The shortcomings of its enrollment solution—which was not ready for an immediate influx of new applications—could result in bottlenecks and inefficiencies, leading to a less than satisfactory customer experience. Its existing solution was primarily driven by manual reports, making it difficult to process applications. It also needed the ability to process applications on a first-in, first-out basis to meet Centers for Medicare & Medicaid Services (CMS) guidelines. SelectHealth needed a solution that would give it better visibility into enrollment to drive improvements in performance and efficiency. Being satisfied with the other Cognizant TriZetto solutions already in place, SelectHealth chose us yet again.


Our Approach

The Cognizant healthcare technology team’s familiarity with SelectHealth’s existing solution helped us while implementing and transitioning the health plan to the TriZetto Elements® Enrollment Administration Manager (EAM) Workflow solution, making the onboarding process seamless. The EAM Workflow dashboard provides greater clarity on SelectHealth’s performance. A clear view of the status of all its applications enables the health plan to process applications in a timely and efficient manner. The dashboard also enables SelectHealth to see and anticipate workflow more effectively, spot potential bottlenecks and lags, and monitor performance to ensure that everyone performs up to the internal standards set by the health plan.

Efficient Application Processing Opens Up New Opportunities

Two years after migrating to the EAM Workflow solution, SelectHealth continues to process enrollments in a far more efficient and timely manner—and this has opened up new opportunities. Cognizant’s solution gave SelectHealth the customization it needed as it entered a new market focusing on Medicare. By adopting first-in, first-out standards, SelectHealth team members are able to work together efficiently. The health plan can monitor an individual’s performance and productivity, and shift people across tasks as required. It can also appropriately justify, anticipate and prevent the need for staff overtime. Moreover, the solution helps SelectHealth meet CMS guidelines and compliance regulations.

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$22,237

estimated yearly salary savings based on increased efficiencies for two to three employees

100%

audit of the processed applications

First-in, first-out

application processing


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