UnitedHealth Group – Enhancing System Integration and Operational Flow
Introduction
Client Background
UnitedHealth Group (UHG), a global leader in healthcare and insurance, enhances healthcare through innovation, technology, and value-based care via UnitedHealthcare and Optum.
Project Goal
The goal was to streamline UHG’s marketing and operational systems, reduce inefficiencies, and enhance the accuracy and speed of claims and appeals processing.
Project Timeline
— 12 Months/
Research/Discovery
Planning
Execution
Deployment
Testing/Iteration
Challenge
Escalated issues, overturned appeals, and incorrect claims increased costs and inefficiencies.
- Over 7,000 issues escalated monthly to the USS Customer Advocate team.
- 56% of appeals were overturned, leading to an 87% increase in associated costs.
- Routine claims were failing to adjudicate correctly, resulting in inefficiencies.
Solutions
Strategy
Cannsult partnered with UHG to implement a system integration strategy, aligning teams, technology, and workflows to reduce waste, boost automation, and improve outcomes.
Approach:
- Diagnosed UHG’s systems and prioritized improvements based on data insights.
- Worked with cross-functional teams to address delays and inefficiencies.
- Used lean and agile methods to shorten timelines and drive adoption.
Execution:
- Reduced escalations by 40% and optimized claim adjudication through an integrated system.
- Lowered appeal overturn rates and automated routine tasks.
- Cut IT project cycle time by over 30% and improved Medicare payment accuracy.
Results
43%
Drop in monthly escalated issues, from over 7,000 to under 4,000.
45%
Reduced appeal overturn rates, cutting associated costs.
30%
Fewer manual intervention calls with more reliable claims adjudication.
30%
Faster IT project cycle times, speeding execution and delivery.
Conclusion
Cannsult’s partnership with UHG leveraged data-driven strategy and system integration to resolve operational challenges, improving efficiency, reducing costs, and enhancing customer service, reflecting Cannsult’s commitment to sustainable results.
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