In today’s value-based world, success in an increasingly demanding health insurance environment relies on the most efficient processes, the smartest data management, and the most responsive customer support. It isn’t enough to fix problems – you need to be able to proactively assess your operations to identify potential problems before they have a negative impact on the customer experience, your revenue and reputation.
Your processes, platforms and resources must be automated, intelligent, and comprehensive to keep up with the speed and complexity of the industry.
Our solutions apply expert process analytics, customer intelligence, and advanced automation to not only rectify problems, but eliminate obstacles that lead to revenue loss, regulatory action, or member and provider dissatisfaction.
Throughout all administrative processes, internal and external audit tools, robotic process automation (RPA), and machine learning help us to accurately identify and respond to errors.
When errors are made or inefficiencies are discovered, Firstsource uses the Six Sigma “Five Whys” model for root cause determination to determine why the issue arose, how it can be corrected, and how such issues can be avoided in the future. By identifying problems and assessing the root causes, we apply smart, automated, customized solutions that save healthcare payers money, increase efficiency and accuracy, and improve member and provider satisfaction.
Firstsource ensures its agents perform to your high standards for quality. We conduct regular assessment of our own quality assurance team through regular calibration sessions with our team and yours. We also review our own call center agents’ calls on a frequent and regular basis, in accordance with the client’s preference, for a comprehensive quality review.
Our proprietary First Customer Intelligence solution enables us to mine data from customer interactions via email, phone, social media and web chat to provide actionable insights for improved service. Results are shared with you and our internal teams via our automated quality review and reporting (QRR) database.
Our Quality Assurance services can help resolve problems and increase efficiency in every aspect of your operations:
It took a large US Health Plan 20-25 minutes to complete a provider request, at 98% accuracy rate, and 10 days for information to reach its provider contract and data management (PCDM) platforms. Firstsource helped this Health Plan:
One of the largest healthcare payers in the U.S. was faced with >10 days TAT on claims and $21 million per year of incorrectly paid claims. Firstsource help them to:
Our clients include 12 of the top 20 Health Plans nationwide
Our solutions are backed by Robotic Process Automation, advanced analytics and more
With our 20+ years' experience in the field, you'll know your customers are in good hands