Strategic Initiative Proposal
Operations
Transformation
Intelligent automation and unified platforms across Claims, Authorizations, and Member Services driving operational excellence.
Executive Summary
Strategic initiatives prioritized by impact, feasibility, and alignment with operational goals.
Digital Intake (Sorting & Indexing)
Transform physical document processing with intelligent digital sorting and automated indexing across Claims and Auth & Corro channels with 90% Straight Through Processing rate for Sorting and 95% extraction accuracy
Scan mail at receiving location, perform automated sorting on digital copies, introduce extraction tooling with high field accuracy, leverage shared platform across both tracks
Macess Replacement
Replace Macess File Cabinet platform with modern solution. Proposal details available in Digital Intake deep dive. Partially addressed by Digital Intake Solution which covers Work Queues, DocViewer, and DocTriage functionality. Additional effort required for File Cabinet (document management) replacement.
Leverage Digital Intake platform components for work queues, document viewing, and document triage. See Digital Intake section for detailed proposal, implementation timeline, and cost analysis.
360 Member View
Enable claim examiners to work significantly faster using a single unified interface with all required information at hand: claims history, auths, referrals, pricing calculator, interactive document viewer with content search. Eliminate constant system-switching and reduce review time per case. Strategic goal: abstract away underlying legacy systems from end users, creating foundation for tooling modernization
Replace Macess Docviewer with advanced Review tool. Improvement and evolution of in-house tools like Fixer with enhanced capabilities: unified data aggregation layer, in-app pricing calculator, full-text document search, collaborative annotations. Collaborative effort with in-house team to build unified front-end layer
IDM Enhancement / Potential Replacement
Analyse and potentially replace legacy Crystal Reports-based IDM system for letter generation and correspondence scheduling
Phased migration to modern correspondence management with template modernization
Voice-Bots
Introduce automated GenAI-based voice machines wherever applicable based on current technology capabilities
Identify best candidates in terms of call frequency, complexity, and time consumption per communication type, then introduce bot replacements for high-volume routine interactions