Operations Optimization

Operations Optimization


Health plans continue to stride toward better business performance by improving their claim operations and their services to providers, consumers and employers. Given the regulatory hurdles and increasing external pressure, payers are being closely monitored for process efficiency and operational optimization, as a way to contain the medical loss ratios. For the claim process in particular, insurers are looking to reduce the claim turnaround time, open claims inventory, to increase claim handling quality and optimize the utilization of claims examiners.


Claim Operations Views is a comprehensive healthcare payer tool based upon the claims processing life cycle which automatically tracks, documents, reports on, and analyzes each important juncture from cradle to grave. It follows a payer’s claims inventory from receipt through processing while simultaneously reaching out to the processing system for adjustment/post processing events to include in the reporting and analytics. It does all of this with a particular consideration of the time component of equations and a focus on impacted customers both internal and external. Visual Intelligence’s product OperationVIews covers near real time reporting on current inventory to long term analysis of claims inventory over different timeframes. The claim process analysis is measured via evolving KPI indicators based on different stages of a claim lifecycle. In addition, many other operations objectives are measured and reported for provider services, employer accounts, workforce productivity, call center activity and performance benchmarks.


While there are many other tools that aim for the same target, what differentiates ClaimOperationsVIews is how it integrates industry knowledge and experience with real time technology. It is both plug and play and highly customizable so that it can address industry wide concerns as well as company specific issues. Claim Operations Views has achieved what many tools have tried and failed to do before in that it truly can work with vast amounts of data in multiple formats while maintaining split second response time and extremely low maintenance and enhancement costs. Finally and most importantly, due to the experience behind the tool, it speaks to healthcare operations personnel from the claims analyst to the COO in familiar, relevant, and actionable terms with real time accurate data feeding relevant customizable metrics.


Health care operations departments, claim analysts, customer service representatives, sales department