The Client:

Global Excel Management Inc., is a health insurance claims management company and provides assistance, medical case management, cost containment and claims services. GEM is a wholly owned subsidiary of Expert Travel Financial Security (ETFS) Inc. ETFS provides insurance to students, groups, individuals, and expatriates in the areas of travel and health.

The Problem:

Recent business opportunities at GEM make it evident that they will need to process even higher volumes of bills quickly and accurately. GEM needs to be super-efficient to satisfy client demands in new markets and to be competitive on pricing and quality with short turnaround times.

In order to meet these demands, GEM explored the option to outsource the claims data capture and assessment functions. In addition they also required assistance to better manage workflow peaks and valleys.

GEM management team decided that they would need an experienced partner that could rapidly provide knowledgeable and well skilled claim administration. They chose Inteq for this challenging task.

Our Approach:

Inteq team partnered with GEM team members to create process documentation, working arrangement model detailing the transition plan and SOPs. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met. Inteq’s experience in managing Business Process Outsourcing (BPO) engagements made the claims administration process transition to offshore an immediate success.

Data capture: As requested by GEM, Inteq commenced with data capture of HCFA and UB claim forms using clients CAI and e-file applications, the keying conventions and standard operation procedures received from GEM. Each day’s claims processing is returned complete by the time GEM employees report to work the next morning i.e. 24 hours TAT. The data capture service was extended to include white bills, self-paid bills, QT and e-Repricing bills.

Claims Assessment:

• Validation of claims in client’s software in accordance with the policies and rules pre-specified by the client
• Claims adjudicated upon by the adjudicators who are well trained on taking decisions on health claims
• Auditing of claims adjudicated

Inteq set up a two member transition team to go to client site for facilitation of transition of the claims assessment process. Activities undertaken onsite were process mapping, training and documentation.

During the onsite phase a number of activities were performed simultaneously offshore. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met. The offshore launch and level one productivity and quality levels were achieved as per plan.

Benefits:

The results were dramatic.

• Improved quality and processing time of claim administration functions
• Enhanced and expanded management reporting and decision support capabilities.
• Improved turnaround time and being achieved consistently
• Reduced manpower requirements
• Improved accuracy levels
• No backlogs

This timely and cost effective method of claims administration has allowed Inteq to consistently achieve our accuracy guarantee to GEM. The Company has engaged Inteq as their offshore partner for BPO services.

The Client:

Global Excel Management Inc., is a health insurance claims management company and provides assistance, medical case management, cost containment and claims services. GEM is a wholly owned subsidiary of Expert Travel Financial Security (ETFS) Inc. ETFS provides insurance to students, groups, individuals, and expatriates in the areas of travel and health.

The Problem:

Recent business opportunities at GEM make it evident that they will need to process even higher volumes of bills quickly and accurately. GEM needs to be super-efficient to satisfy client demands in new markets and to be competitive on pricing and quality with short turnaround times.

In order to meet these demands, GEM explored the option to outsource the claims data capture and assessment functions. In addition they also required assistance to better manage workflow peaks and valleys.

GEM management team decided that they would need an experienced partner that could rapidly provide knowledgeable and well skilled claim administration. They chose Inteq for this challenging task.

Our Approach:

Inteq team partnered with GEM team members to create process documentation, working arrangement model detailing the transition plan and SOPs. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met. Inteq’s experience in managing Business Process Outsourcing (BPO) engagements made the claims administration process transition to offshore an immediate success.

Data capture: As requested by GEM, Inteq commenced with data capture of HCFA and UB claim forms using clients CAI and e-file applications, the keying conventions and standard operation procedures received from GEM. Each day’s claims processing is returned complete by the time GEM employees report to work the next morning i.e. 24 hours TAT. The data capture service was extended to include white bills, self-paid bills, QT and e-Repricing bills.

Claims Assessment:

• Validation of claims in client’s software in accordance with the policies and rules pre-specified by the client
• Claims adjudicated upon by the adjudicators who are well trained on taking decisions on health claims
• Auditing of claims adjudicated

Inteq set up a two member transition team to go to client site for facilitation of transition of the claims assessment process. Activities undertaken onsite were process mapping, training and documentation.

During the onsite phase a number of activities were performed simultaneously offshore. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met. The offshore launch and level one productivity and quality levels were achieved as per plan.

Benefits:

The results were dramatic.

• Improved quality and processing time of claim administration functions
• Enhanced and expanded management reporting and decision support capabilities.
• Improved turnaround time and being achieved consistently
• Reduced manpower requirements
• Improved accuracy levels
• No backlogs

This timely and cost effective method of claims administration has allowed Inteq to consistently achieve our accuracy guarantee to GEM. The Company has engaged Inteq as their offshore partner for BPO services.

The Client:

Global Excel Management Inc., is a health insurance claims management company and provides assistance, medical case management, cost containment and claims services. GEM is a wholly owned subsidiary of Expert Travel Financial Security (ETFS) Inc. ETFS provides insurance to students, groups, individuals, and expatriates in the areas of travel and health.

The Problem:

Recent business opportunities at GEM make it evident that they will need to process even higher volumes of bills quickly and accurately. GEM needs to be super-efficient to satisfy client demands in new markets and to be competitive on pricing and quality with short turnaround times.

In order to meet these demands, GEM explored the option to outsource the claims data capture and assessment functions. In addition they also required assistance to better manage workflow peaks and valleys.

GEM management team decided that they would need an experienced partner that could rapidly provide knowledgeable and well skilled claim administration. They chose Inteq for this challenging task.

Our Approach:

Inteq team partnered with GEM team members to create process documentation, working arrangement model detailing the transition plan and SOPs. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met. Inteq’s experience in managing Business Process Outsourcing (BPO) engagements made the claims administration process transition to offshore an immediate success.

Data capture: As requested by GEM, Inteq commenced with data capture of HCFA and UB claim forms using clients CAI and e-file applications, the keying conventions and standard operation procedures received from GEM. Each day’s claims processing is returned complete by the time GEM employees report to work the next morning i.e. 24 hours TAT. The data capture service was extended to include white bills, self-paid bills, QT and e-Repricing bills.

Claims Assessment:

• Validation of claims in client’s software in accordance with the policies and rules pre-specified by the client
• Claims adjudicated upon by the adjudicators who are well trained on taking decisions on health claims
• Auditing of claims adjudicated

Inteq set up a two member transition team to go to client site for facilitation of transition of the claims assessment process. Activities undertaken onsite were process mapping, training and documentation.

During the onsite phase a number of activities were performed simultaneously offshore. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met. The offshore launch and level one productivity and quality levels were achieved as per plan.

Benefits:

The results were dramatic.

• Improved quality and processing time of claim administration functions
• Enhanced and expanded management reporting and decision support capabilities.
• Improved turnaround time and being achieved consistently
• Reduced manpower requirements
• Improved accuracy levels
• No backlogs

This timely and cost effective method of claims administration has allowed Inteq to consistently achieve our accuracy guarantee to GEM. The Company has engaged Inteq as their offshore partner for BPO services.