Success at Health Insurance Licensee

With change being the only constant in the health insurance market; See how this Blue Cross provider keeps up with serving their members well.

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Challenges

  • Changing insurance industry regulations – from requirements to offer individual policies, to participate in health insurance exchanges to the removal of these requirements – raises big questions on how the potential and ever changing regulatory requirements will impact their members and business model.
  • Need effective member master data system to model current state and assist with predicting future state with member and business impacts – current BI and Analytics system cannot handle complexity of current and future needs.
  • Legacy flat file system cannot handle all member data including current and history. With the regulatory changes – member history is important especially if they were previously served in a group profile and now need individual services. A complete historical and accurate picture of a member over time is mission critical information to serving all members well.

Strategy

  • Select master data management software that works on the Microsoft stack with a quick implementation timeline.
  • Build an MDM solution to replace existing legacy system; while also building a future proof solution to support analytics requirements, link member and group data across the organization and gain internal self-sufficiency to handle ongoing requirements/changes.
  • Create a clean master list of members and groups: eliminate duplicates, verify addresses and ensure complete and correct member data by including Dynamics CRM data.
  • Create golden records with automated matching and mastering including a data stewardship business process for approving/resolving match results. Use Profisee Accelerator services to replace legacy master system with Profisee Platform in under one quarter.

Outcome

  • Eliminated duplicate broker fees that were being paid on member referrals due to clean, trusted member and group data.
  • Duplicate, bad data removed and new workflow and business process for member onboarding has been created and deployed across the organization. The new business process eliminated the data entry errors across the entire workflow.
  • Success with member and group data in the Profisee Platform has led to the addition of master product data and monetizing the intersection of member, group and product data as a solid foundation for their enterprise business strategy.
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