Health Insurance Exchanges: Is Your Back Office Operation Ready?

By now, your organization has already contemplated the merits of selling insurance products on the new health insurance exchanges, set to go live and begin accepting enrollees October 1, 2013 in the U.S. 

In addition to ramping up customer service and enrollment processes to support the new members that register via the exchanges, companies participating in the exchanges must also consider the behind-the-scenes processes that have a big impact on the customer experience.  Billing, collections and claims processes will need special attention as both volume and complexity increase.

New members may pay for premiums and services through subsidies, and back office departments must be able to efficiently process manual claims (those that are not auto-adjudicated), as well as resolve complaints in a timely manner.  A better understanding of current best practices in claims processing can help payers increase efficiency.  Unfortunately, most companies do not have the visibility into their processes needed to make meaningful change. 

So, what are some of the ways that back offices can prepare for the go-live of health insurance exchanges?

1. Desktop activity monitoring

It’s common for productivity rates in back office claims processing environments to hover around 50 percent, compared to productivity rates as high as 85 percent in other parts of the organization.  Most companies can achieve a 10 percent increase in back office productivity just by monitoring desktop activity and making a few simple changes to their claims processes.  Incremental changes can bring big dividends to companies willing to start the process of achieving more competitive productivity rates.

2. Forecasting & proactive management

Other back office innovations include managing work inventory proactively and forecasting processing demand accurately.  These innovations allow payers to staff their organizations appropriately to deal with the increase of new members.  Understaffing can compromise the customer experience, and overstaffing has a negative impact on profitability.  In an increasingly customer-focused, competitive environment, payers can’t afford to overlook any opportunity to forge positive connections with members, nor leave profit on the table.

3. Enhanced customer experience

If you have already begun the process of getting ready for this new opportunity, then you know that health insurance exchanges are a unique opportunity to reach new customers.  Ensuring an optimal experience at all customer touch points is critical component of maximizing the potential of this market.  Customers expect quick turnaround times for their claims and timely responses to their inquiries, and you need to be ready to meet their expectations. 

While a good customer experience begins with enrollment, keep in mind that great customer service always extends to the back office.

Health Insurance Marketplace by State


Source: National Conference of State Legislatures, Federal Health Reform: State Legislative Tracking; Center on Health Insurance Reforms, Georgetown University Health Policy Institute; Commonwealth Fund analysis. 

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