Case Study: Automation of Appeals & Grievances for a Leading Health Plan


Automation of Appeals & Grievances for a Leading Health Plan

Find out how the customer could drive member-centric process while improving its star ratings.

About the Health Plan 

The Health Plan is a managed care organization, serving nearly 25,000 members. With a view to enhance member experience and ensure compliance, the Health Plan decided to streamline its document-intensive appeals & grievances process.

Need for automating Appeals & Grievances 

The Health Plan’s customer service department received various Medicaid and Medicare appeals and grievances cases from multiple channels on a day-to-day basis. The department relied on multiple systems and collaborated with various departments. The result was high turn-around-time and the risk of non-compliance due to non-standardization of the process. To address these challenges, the Health Plan realized the need to streamline its appeals and grievances process.

How the health plan could improve its compliance adherence by 98%?

Partnering with Newgen, the organization gained operational efficiencies and expedited its resolution process. With end-to-end visibility and easy tracking of cases, the company improved its overall member satisfaction. Further, extensive audit logs and reporting enabled the Health Plan to ensure compliance. Download the document to view the full case study.