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Health Care Case Study

Case #12006: Medicare Part D/Medicare Advantage Interim Leadership

The Senior Services division of a national Health Benefits Organization had recently launched a Medicare Part D product and was looking to expand their Medicare Advantage (“MA”) products. Questas was engaged to assist the Product Development, Sales & Marketing, Compliance and Operations areas with preparing for this new product launch and helping to develop the infrastructure to meet this new business growth. Additionally, Questas was asked to provide interim leadership to oversee the Operations areas while new applications were received and processed, incoming member calls were received, and resulting Medicare claims were processed – on three separate systems.

Questas provided a team of resources that included senior operations leaders, project managers, business analysts, consultants and trainers to supplement the client’s resources and meet the demands of new business volumes, existing member services and growth in new product lines.

Our client wanted to provide seamless service for new products while at the same time selecting outside vendors to assist increased volumes, on-boarding and training new associates and gaining compliance with new products and regulations that were daily being changed and re-defined by CMS and the marketplace.

Engagement Highlights

  • Industry:
  • Health Insurance
  • Client:
  • A National For-Profit Health Benefits Organization
  • Assignment:
  • Provide interim leadership support, PM, BA, training, consulting and leadership resources
  • Establish new processes and procedures for accurate and timely processing
  • Pursue outsourcing opportunities to increase efficiency
  • Gain and maintain CMS compliance
  • Train internal resources and external vendors
  • Service ongoing business
  • Respond in a timely manner to CMS, groups, members, providers and internal stakeholders
  • Approach:
  • Provided resources to supplement client team
  • Trained the “trainers” to quickly develop and gain processing accuracy
  • Conducted daily on-the-floor training and feedback
  • Documented all new processes on-line for all associate access to ensure employee engagement, gain compliance and improve service
  • Duration:
  • 21 months


  • Led while creating a permanent infrastructure for future growth
  • Trained internal resources to assume new roles and responsibilities
  • Imparted operational leadership disciplines and training
  • Growth of over 1.3 million members
  • Successfully transitioned all roles to internal client resources

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