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Claims Processing

ChallengeAccording to a recent AHIP study, the average cost of processing a medical claim was reported at $1.36 per claim. The average cost of processing an auto-matically adjudicated claim was $0.99 per claim; the average cost of process-ing a “pended” or delayed claim (often a claim that requires additional infor-mation or more complex manual pro-cessing) was $3.99 per claim. Health care payers are feeling costs pressure from excessive overtime, contractors and general labor costs to manage the claims process.

The costs are broken down into several factors:• Costs of FTEs manning claims pro-

cessing centers • Complexity of pended claims and

challenges to automate• Ability to accurately and automat-

ically track claims inventory and processing time

SolutionThe key to reducing operational costs is identifying and improving the effi-ciency of the processes and activities to complete a claim.

WorkiQ provides the detailed opera-tional intelligence and workforce ana-lytics needed to improve productivity.

WorkiQ Workforce Analytics identifies the following in real-time:• Average units of work and average

time to complete specific process-es. This helps to identify poten-tial bottlenecks and productivity drains.

• Processes and work steps that can be eliminated or automated to im-prove throughput and accuracy.

• Categories of work and claims staff productivity. This enables claims managers to perform “in the mo-ment coaching” and balanced work allocation.

BenefitsThe WorkiQ solution provides event-based intelligence to quickly lower the overall costs of operations.

Benefits include:• Compare “true” employee produc-

tivity by taking into account the mix and complexity of the work they handle

• View most frequently utilized ap-plications and websites in real-time

• Identify productive activities and time spent by associates in these activities

• Compare all examiners on multi-ple types of productivity and work items

• Evaluate FTE utilization• Improve your employee engage-

ment and accountability• Automate desktop activities or

augment the user as they perform their job function

WorkiQ® makes it easy to understand and visualize employee performance. It enables the organization to go beyond simple statistics and self-reporting, cre-ating actionable insights that drive real improvements within your business.

AboutThe WorkiQ® solutions drive produc-tivity improvements throughout your workforce. WorkiQ® Workforce Analyt-ics provides visibility across the organi-zation of what, how much, and how ef-

fective employees complete their work. Only WorkiQ® provides the visibility to know exactly what work is being done, how it is actually being done, and the quantitative measures required to im-prove workforce productivity.

Solution Brief - Health Plans

(972) 888-0407

www.workiq.com

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