Healthcare insurers in the US are facing increasing imperatives to drive down their administrative costs in areas such as Claims and Member Services, while improving quality and service. 

The back and middle office functions of claims processing and member management provide excellent opportunities for much needed improvements. Enlighten’s transformation program and its supporting SaaS metrics and planning systems provide the performance changes you are looking for—without the need to change your current IT systems, and without disruptive outsourcing. Over the course of twenty weeks the program will transform your back-office culture. Your teams will be focused on performance and quality, fueled by the analytics that give every team member and manager productivity, efficiency and quality metrics.

Featured Examples of our work with clients

Pharmacy Benefit Management

Helping fast-growing US provider of pharmacy benefit services standardize processes and improve efficiency to provide the best care for patients at the most appropriate price – Improved daily output per FTE by 13.4% in back office and by 15.2% in call center while improving service levels

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Healthcare Insurance

Helping 60,000 member healthcare fund improve productivity across Member Services, Hospital Services and Claims, while maintaining positive workforce culture – 15-20% productivity improvement and dramatic reduction in overtime over 22 week program

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Healthcare Insurance for Union Members

Helping 110,000 member private health insurer reduce backlogs and cycle times to better serve members - 66% reduction in backlog and 37.5% productivity gain in 20 weeks

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