CHALLENGE

Migrating Healthcare Plans

Due to the complexities involved with handling healthcare plans, many employers are utilizing software to assist them. This was the case recently for a longstanding health plan partner who wanted to migrate their $3 million Medicare Advantage membership plans to HealthRules Payer. HealthRules Payer is one of the top core administrative processing systems around. 

 

The health plan partner wanted to migrate their Medicare Advantage Plans to HealthRules with zero business disruptions while also achieving an aggressive scale-up in claims. To make the migration and scale-up as seamless and fast as possible, they turned to Sagility for assistance.

SOLUTION

Identifying Staffing Needs

To achieve the desired plan migration and upscale claim processing, Sagility determined how many new staff members would need to be added. Using our Workforce Management Team, we determined that the client would need a staff increase of 276 FTEs spread across four different employee waves. By adding team members in four waves, we ensured that the client would be able to handle the future increase in claims without adding employees too quickly. 

 

In addition to adding new team members to handle claims, the Workforce Management Team also seeded individuals to lead the new team. This included Trainers, Processors, Team Leaders, Managers, Quality Associates, as well as Mentors from the Medicare and ACAS Claims processing teams.

SOLUTION

Division of Labor and Open Communication

For risk management purposes, it was determined that 25% of the overall headcount would operate out of the BCP site. This also allowed for the gradual transition and increase in the labor force. 

 

To ensure that the client remained in the loop about everything that was happening, Sagility conducted bi-weekly meetings with them. We also tracked everything we did using a detailed and meticulously outlined Gantt Chart. This chart contained everything from hiring, training planning, and batch planning to client requests for access to applications, reporting, and governance planning.

SOLUTION

Training and Mentoring

The final phase of the plan was to train and mentor all of the new hires, one wave at a time. To ensure their system and processes were kept in place, the client remotely trained and mentored the pilot batch of workers. All ensuing waves, 2-4, were mentored and trained by Sagility-trained staff from the first wave of employees. To ensure quality control of personnel, buffers were added via an external Quality Auditing Program.