Case Study: a major health plan recovers $9M in missed COB savings with Conduent

Helping a major health plan leverage CAQH COB Smart files to recover millions through previously unidentified Coordination of Benefits opportunities

The customer, a major health plan company, was struggling to identify and act on Coordination of Benefits (COB) opportunities using its CAQH COB Smart data, leaving an estimated $5 million in annual recoveries unrealized. The high-volume data required extensive validation expertise the plan lacked, causing them to miss opportunities for recoveries and future cost-avoidance savings, especially for members aging into Medicare.

Conduent implemented a customized solution that leveraged its proprietary data analytics, multiple data sources, and algorithms to validate the plan's CAQH files. This approach identified the timing and primacy of other coverages, turning stagnant data into actionable recoveries. As a result, Conduent helped the plan recover $9 million in previously missed payments since 2018 and an estimated $5 million in 2021.