Claims Processing

Claims Processing is heavily dependent on system responsiveness to enable productive and efficient processing operations.

The changing landscape of claims processing in the health care and insurance industry is driving the increased use of Business Process Outsourcers (BPOs).  In the past, managing claims inventory was easier when turn-around-time, worker hours, and inventory levels were the only elements to balance.

The inclusion of BPOs and the changing nature of those arrangements from lower cost staff augmentation to a pay-per-claim model increases the complexity of managing claims inventory.  The impact of application performance on an off-shore or remote claims agent can be significant and potentially result in per-claim cost increases.

Through the implementation of Application Performance Management (APM ), aligned with the needs of claims processing, Evidant's solutions allow executives to:

  • Minimize risk to productivity or possible fines caused by the IT infrastructure
  • Understand application availability and performance from the claims agent's perspective.
  • Quantify the impactof application performance - both in terms of
    • Total time lost due to application issues, and
    • Business impact in dollars due to applications issues
  • Provide a framework for setting SLO/SLA's for application performance expectations with a current or future BPO.
  • Provide an engagement model to work with IT business partners about the impact of application availability and performance issue.
  • Provide a framework to make infrastructure decisions.
  • Provide inventory management teams with real-time insight into application performance to enable them to react faster to help insure inventory targets are met.

 

Sample Reports