Case Study: FirstCare Health Plans achieves dramatic claims-processing efficiency — cutting pending claims from 80,000 to 6,000 with Information Builders' WebFOCUS

FirstCare Health Plans Uses WebFOCUS to Manage Rapidly Growing Business

FirstCare Health Plans, a Texas-based insurer serving members since 1985, faced rising membership and the complexity of migrating between two claims systems and data warehouses. Disparate reporting, no unified KPIs across finance, claims, pharmacy and other functions, and a large backlog of pending and disputed claims made it difficult to track processing, revenue and operational performance.

Using Information Builders’ WebFOCUS, Visual Discovery and Professional Services, FirstCare built unified BI dashboards, guided ad hoc reporting and departmental KPIs tied to annual goals, enabling self‑service analytics and drill‑through investigation. The solution cut pending claims from 80,000 to 6,000 and appeals from ~60,000 to ~10,000, improved claims‑processing efficiency and provider retention, reduced ad hoc report requests, and set the team up for mobile BI and advanced visualization.

FirstCare Health Plans

Lori Wheeless

Director of BI