Case Study: a large national healthcare insurer achieves 30% UM efficiency gains with EXL

Large National Healthcare Insurer - Customer Case Study

EXL worked with a large national healthcare insurer, a top-five national health plan with over 400 million members, that needed a strategic partner to bring innovation, efficiencies, savings, and recurring process improvements to its utilization management operations. The insurer’s UM process depended on a large staff and was often short-handed, creating the need for stronger staffing support as well as deeper utilization management expertise, analytics, technology, and innovation.

EXL used its Process Excellence team and Healthcare Academy to analyze and improve the insurer’s UM operations, recruit and train clinical and non-clinical staff, and certify Philippines-based nurses as USRNs. EXL eliminated the staffing shortage and now delivers UM services across three delivery centers in the Philippines and one in Pune, India, with more than 400 in-house domain experts handling over 4,000,000 annual requests. The engagement also delivered strong performance results, including 99.5% over-performing volume within TAT, 99% commercial and Medicare volume within TAT, 100% outperforming contact center service levels, and a 98% quality score against a 95% target.