CASE STUDY
Industry:
Health Insurance
Products / Services:
Medicare BPaaS
End-to-end BPaaS solution for a leading Provider Sponsored Health Plan
Client Background
Client is the largest health insurance provider that offers a variety of insurance plans to individuals and families. The customer’s provider network offers coordinated, high-quality health care to nearly 50,000 health insurance members.
Client Requirements
Client was looking for implementing a solution that will manage all the business functionalities such as Enrollment, Membership management, Appeals and Grievances, Encounter submission, Agent / Broker management and Analytics.
Engagement Highlights
30+
% Increase in
Operational
efficiency
95%
CMS
Acceptance
Rate
2X+
Increase in Member
experience and
Retention
Solution Highlights
The unified solution addresses the challenge of complex and time consuming process of enrollment, whereas tackling the intricacies and inconsistencies of broker commission with a robust commission management module. The platform is compliant with CMS guidelines ensuring all operations are in accordance with the regulatory framework.
Enterprise
Digital Solution
Streamlined end-to-end Medicare operations from enrollment, appeals & grievances to encounters
CMS
Compliant
Successfully created reports and submission capabilities adhered to specific requirements set by CMS, ensuring compliance
Data
Integration
Implemented a unified solution encompassing the integration of both CMS and state data in a single comprehensive system
Automated
Reconciliation
Streamlined & Automated process for membership reconciliation, establishing an efficient and seamless system reducing manual efforts
Streamlined A&G
Process
Automation of A&G processes and generation of Part C and D Universe Reports as per CMS requirements
Real-time
Reports
Provided real-time reports and application status to Health Plan beneficiaries for appropriate decision making
Modernization of a leading BCBS Health Plan
Wipro implemented end-to-end BPaaS platform with Enrollment, Membership, Agent commissions and Encounters.
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Leading Medicare Advantage Start-up Plan Implementation
Wipro helped achieve growth objectives and addressed the pressing business needs for a Medicare Advantage
Health Plan.
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