Case Study
Situation
- Multi-state MBHO (ownership from multiple BCBS plans) interested in offering claims processing capabilities to current and future clients in response to market inquiries and recent RFP requirements
- Recognized need for real-time claims data to enhance the ability to participate in risk contracts and control costs through more robust care management
- No dedicated internal claims operations or system implementation resources
- Multiple stakeholder inputs and requirements regarding claims capabilities and timelines required significant Change Management attention and communications
SMA Services
Strategic Review
Operations Planning
Technology Alignment
Business Transformation
Actions & Impact
- Developed business and technical requirements to support Request for Proposal (RFP) procurement
- Led RFP project involving multiple solution vendors and over 20 internal stakeholders
- Facilitated Executive Management vendor selection and contracting
- Developed Claims System Operating Model and Implementation Plan
- Managed staff hiring efforts, including SPV and Claims Processing Management/Staff recruitment, onboarding, and training
- Documented functional Standard Operating Procedures and client onboarding manual
- Documented User Acceptance Testing (UAT) and Go-Live approval plan
- Led client discussions regarding transition timeliens and performance expectations
- Launched new claims processing capabilities via pilot and scaled program in 12 months