Techrity Consulting

Healthcare Industry Case Study

This health insurance company, is one of the top 3 health insures in the US with over 16 million members and almost 800,000 doctors as part of its network. This company maintains call centers across the globe to service member questions and issues. To support these call centers, policy documentation is generated by company staff that define covered procedures and policy guidelines.

The client needed an efficient way to manage procedure and policy guideline information for their global call centers so that call center staff could access this information quickly and effeciently.

The Problem:

As part of its operation, this company issues hundreds of assorted policy types to companies accross the USA. Each of these policies carries a unique set of heavily documented procedures and guidelines. These guidelines dictate, at the most granular level, the scope & level of coverage for thousands of listed conditions within each given policy.

When members would contact the call center with questions, call center agents would search through hundreds of documents of varying formats to find the proper match for the question raised. They then would have to search within each document for the relevant paragraph or section. This process was tedious, inefficient and often resulted in missing or inaccurate information being provided to their customers. The client needed a solution so that their call center agents could quickly access policy information that was both accurate and current.

Techrity worked with the healthcare insurer to understand the business process and workflow that drove the creation through the final approval of policy documentation. Our team then used this information to model a custom workflow process for managing the authoring of policy documentation utilizing the Worksite MP workflow management tool. This worflow process would be used by policy authors to assure that policy documentation would be properly routed to all reviewers and guarantee compliance with the approval workflow for policy documentation.

Techrity also developed a custom publish process for the policy documentation. Once a document enters the final approved stage in the workflow, a publish process would immediately initiate. This process is a highly sophisticated program that reads through policy documentation, chunks that documentation into single unique topic fragments and then republishes each topic into the Worksite repository as its own document in html format. In addition, the process parses through the content of each topic fragment to extract searchable keywords. These keywords are then associated to that document within the Worksite system as searchable metadata.

This 'chunking' or 'fragmenting' of policy rules or topics immediately provided significant process efficiencies for the client. Where previously call center agents would have to search the content of lengthy pdf files, call center searches now returned only the content (or 'fragment') directly relevant to the search criteria. Just as importantly, the extraction of essential keywords (or metadata) from within the content, provided instant time and cost benefits as it assured the precision and accuracy of search results.

With call centers spread across the globe, maintaining exceptional cross-location communication is vital to assuring a competitive team. To this end, Techrity configured and deployed dedicated workareas, news, discussion areas and other communicative components. These components allowed department heads to provide regular news updates and announcements, maintain open lines of communication, and collaborate over shared content.