Abstract

A national healthcare insurer was challenged by managing resources to perform the Quality Control (QC) function. SDLC Partners assisted the client by creating and implementing an optimized resource allocation strategy.

The Challenge

A national Healthcare Insurer performs an important quality control function within their operational workflow to ensure key customer data is coded and maintained properly in the appropriate systems. Inaccurate or improperly documented characteristics of the products sold to customers can lead to:

  • Regulatory or Financial penalties,
  • Customer dissatisfaction, and
  • Loss of future revenue

This Quality Control (QC) function exists for practical purposes such as ensuring that the operation of the organization’s key customer support and related downstream systems are unburdened by missing, incomplete, or inaccurate information, and that the company remains compliant with federal mandates. Maintaining and managing a staff to perform this quality control function is difficult due to fluctuating demand, difficulty optimizing resource capacity, loss of domain knowledge, and ongoing training and development requirements.

The Solution

SDLC Partners collaborated with the client to design and implement a flexible staffing service that augments the client’s core staff. SDLC utilized a resourcing model that better managed demand and supply of resources and optimized resource utilization. Our team collaborated with the client to develop and prepare resources in the flex team pool by capturing knowledge specific to the health insurer and acted as a catalyst for change by maintaining training and development programs in order to minimize transition as the flex team expands and contracts relative to QC demand.

The Results

As a result of our client’s partnership with SDLC, their QC function was able to:

  • Satisfy peak demands through an optimized resource utilization model
  • Improve their ability to leverage key resources, such as tenured QC analysts, for more value-adding work
  • Instill best practices across the QC organization
  • Conduct effective and time-appropriate training to reduce ramp-up time/cost and increase resource productivity
  • Effectively manage key domain knowledge through capture, retention and management of critical domain
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