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Health Care Case Study

Case #3729: Planning & Program Management - Shared Services Center (SSC) for Claims

A leading national Health Maintenance Organization (HMO) required assistance with planning and program managing its migration from several distributed claims operations to a new shared services center. New Client leadership had determined that the existing decentralized operation did not provide appropriate consistency in processes and results, systems capabilities, economies of scale and appropriate operational risk protections and moved forward with a shared services model that had been proposed but not approved under the previous leadership team.

Questas staff helped the HMO transformation team manage a two-phased project: (i) assess the needs and plan the migration of the various decentralized divisional job roles, required data and local operating and systems features (e.g., unique state health benefit requirements) to the SSC; and (ii) provide experienced large-scale program managers to help the HMO oversee the migration program.

Questas staff also undertook a special project to assess opportunities to in-source or outsource the to-be-consolidated mailroom and data capture activities. This parallel project included requirements definition, an RFI exchange with qualified on- and offshore mailroom & data capture firms, development of a business case and presentation to management for decisionmaking.

Engagement Highlights

  • Industry:
  • Health Insurance - HMO Operations and Systems
  • Client:
  • A large, not-for-profit Health Maintenance Organization (HMO)
  • Assignment:
  • Assess operating, product, local market and data requirements for migration
  • Develop an integrated migration project plan; maintain the consolidated project schedule and regular project reporting system
  • Program manage specific aspects of the divisional and SSC migration programs
  • Evaluate software solutions to resolve niche requirements necessary to the solution
  • Conduct a special project to determine the business case to in-source or outsource a consolidated mailroom and data capture facility for non-electronic claims
  • Draft an SSC governance model; develop risk assessment template for project
  • Approach:
  • Senior Questas leader to act as the focal point for all planning and oversight
  • Senior Questas program managers to lead claims, provider data, financial and IT teams
  • Develop migration scenarios - bias to speeding up the program to accelerate results
  • Participate with leadership to impart skills, experience and knowledge
  • Function as part of the leadership team - facilitate planning and management processes
  • Execute a special project for mailroom and data capture (in/out)sourcing
  • Develop approaches to SSC governance and risk assessment
  • Duration:
  • 18 months - within which the special 8-week project was completed


  • Cleaned up and completed initial in-progress project plans - with and for the SSC business unit, separate divisions and IT
  • Created discrete and overall migration plans - coordinated with divisional and IT leaders, SSC leadership, migration team leaders and system vendors
  • Suggested SSC governance model and risk identification and mitigation approach
  • Built business case for in/outsourcing the consolidated mailroom and data capture facility
  • Managed migration of the first division to the new SSC
  • Client decided to go it alone after the first divisional migration at which point Questas transitioned its activities to Client personnel and disengaged.

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