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Health Care Case Study

Case #12023: Dental Operations Front End Process Engineering and Outsourcing

A large Health Benefits Organization was looking to reengineer their incoming mail receipt, data entry and scanning/OCR operations for the Dental division as well as pursuing outsourcing alternatives to improve the accuracy, cost and efficiency of their “front end” processing.

The operations included both claims and incoming service inquiries. Questas was engaged to assist leadership with quantifying current work load, identifying process improvement opportunities, and to scope and size the operations for potential outsourcing.

While process improvements were underway, our immediate goal was to reduce current backlogs and bring inventory levels to five to seven days work on hand in order to improve current service levels.

Engagement Highlights

  • Industry:
  • Health Insurance
  • Client:
  • A National for-Profit Health Benefits Organization
  • Assignment:
  • Assist Leadership with Reengineering Overall Dental Operations
  • Improve Overall Quality of Processing, Throughout and Productivity
  • Improve Dental Claims First Pass Rate
  • Assess Front End Mailroom, Incoming Claims, Scanning, and OCR
  • Develop Front End Costs of Processing
  • Select Potential Vendors for Outsourcing
  • Approach:
  • Overall Process Review and Identification of Opportunities
  • Limited System Resources for Automation
  • Rapid Inventory Reduction Plans to Reduce Backlogs
  • Quantify Costs for Outsourcing Potential
  • Develop Staff Models and Quantify Workload
  • Develop RFI Requirements and Service Levels
  • Facilitate Negotiations and Cost Benefit Analysis
  • Pursue Both In-House and Outsourcing Alternatives
  • Duration:
  • 21 Weeks


  • Reduced Inventories to 5-7 DWOH
  • Aligned Staff and Work to Daily Volumes
  • Decided to Outsource Data Entry and Maintain Document Management In-House
  • Suspended Decision on OCR until Forms were Standardized
  • Reduced Overall Administrative Costs with Increased Productivity
  • Outsourcing Savings to be Evaluated After One Year Implementation
  • Outsourcing Anticipated to be Expanded to OCR

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