Case Study: California's largest health insurer achieves automated claims and membership reconciliation with Precisely Data360

California Largest Health Insurer - Customer Case Study

California Largest Health Insurer, a nonprofit mutual serving more than 4 million members, relied on disparate systems (Argus, Magellan and Facets) to feed a central book of record but had no automated way to ensure data quality and consistency. This gap exposed the insurer to compliance, financial and reputational risk, unreliable analytics and a poor member experience — so the organization engaged Precisely and implemented Precisely Data360 to address automated reconciliation and validation needs.

Precisely used Data360 to run weekly and month‑end reconciliations (capturing claim header and detail levels), provide ad‑hoc exception reporting and surface up to 22 separate reports of orphaned records between sources. Precisely’s solution improved accuracy and completeness in the book of record and data mart, increased data trust, mitigated regulatory/financial risk and reduced time and costs associated with manual reconciliation.