Case Study: Global Regional HealthCare Service Provider achieves streamlined payment integrity and unified reporting with Optum

Global Regional HealthCare Service Provider - Customer Case Study

Global Regional HealthCare Service Provider engaged Optum to perform a comprehensive Payment Integrity (PI) assessment after finding PI activities scattered across departments with no standardized metrics, inconsistent methodologies, and below-industry recovery rates. The customer faced inter-departmental reporting misalignment, missed high-dollar and pharmacy claim opportunities, and inefficiencies that hurt profitability and visibility.

Optum delivered an end-to-end PI assessment, a roadmap to realign departmental incentives, and a list of solution partners to support a revamped PI program. Optum’s recommendations streamlined PI processes and reporting, enabled new programs, improved corporate PI alignment and visibility, and positioned the customer to recover previously missed opportunities while evaluating consolidated vendor strategies.