Billing & Finance Solution for Claims Processing System

Case Study:

Billing & Finance Solution for Claims Processing System

Project Mission and Background

A large insurance payer was in the process of replacing theirs core systems with a more advanced product.  The existing systems were inefficient due to outdated technology and have been a constraint to acquiring new business.  Manual efforts caused by system inflexibility cost the company an estimated $35M in the year prior to the project kickoff.  Administrative costs were 50% higher than the competition.  In addition, the company’s growth plans hinge upon a successful rollout of the new system.   One of the key project functional areas was billing and finance.   To be successful, the new system had to offer more robust, flexible and efficient billing options.   

 

Challenges

Bills were previously generated across multiple platforms with numerous internal interfaces and some manual workarounds.  The expenditures associated with managing the billing and finance function were contributing to the uncompetitive administrative costs.  In addition, as the company moved to the new core system, the transfer of legacy data had to coincide with the rollout of the new billing and finance processes.

Our Approach

Lewis Fowler had key resources throughout the Program Office and project leadership positions.  As the program progressed, the billing and finance solution became one of the most visible and critical needs.  It had become a critical path item and needed strong leadership. The client recognized the strong contributions of the Lewis Fowler team, and put one of our project managers in charge of the billing and finance solution. 

Our project manager successfully led the billing and finance project by:

  • Thoroughly documenting current state and future state data flows and system interfaces
  • Driving detailed requirements by working collaboratively with the Finance organization
  • Methodically identifying and categorizing risks while developing mitigation plans with the assistance of key technical resources
  • Cohesively managing a team with numerous work and time constraints

Direct Benefits

With Lewis Fowler, our client got off to the right start and has the tools in place to properly control scope and schedule while keeping an eye on costs.  There are experienced people managing the most critical projects and the PMO is getting the projects staffed expeditiously, while being ready to accommodate the influx of contractors required for a program of this size.

Summary

A program’s success hinges on the ability to find solutions around the functional processes.  The program impacts every business group, but billing and finance are found to be vital to the success of the effort.  Project management expertise and leadership are needed to drive complex work around a tight schedule in order to achieve benefits promised by program sponsors. 

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