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Health Care Case Study

Case #3952: Federal Employee Program (FEP) - Regional Consolidation

A leading Health Insurance and Managed Care company had acquired several other complimentary Health Insurance and Managed Care companies. Once the acquisitions were completed it was decided that, in order to achieve the economies of scale expected from the acquisitions, the claims processing for the Federal Employees Program (FEP) would be consolidated from seven locations to one. The Customer Service functions would be consolidated initially to three locations from seven and a plan would be developed to operate them as a single 'Virtual Call Center'.

We were asked to improve quality, service and productivity of the claims and customer service areas during and after this functional consolidation; and to create the infrastructure, transfer of knowledge and skills, tools and models to ensure the institutionalization of implementation skills. The scope of this FEP initiative spanned Claims in one location and Customer Service in a five locations as they transitioned to three locations.

Engagement Highlights

  • Industry:
  • Health Insurance - Federal Employees Program (FEP) Product
  • Client:
  • A Multi-state Leading Insurance and Managed Care Company
  • Assignment:
  • Assist client in streamlining and developing standard processes across all locations
  • Establish Baseline measurements of Claims Resolved per paid FTE, Inquiries Handled per paid FTE, and Groups or Members per paid FTE, incorporating these into staffing models
  • Facilitate FEP leadership development
  • Identify, quantify and help prioritize system enhancements to achieve improved productivity and quality in the claims and customer service areas
  • Install Phone Tiering Models in the three consolidated Customer Service locations to improve service and productivity
  • Improve the training curriculum and consistency of documentation and development of the infrastructure for consolidation, ownership and perpetuation of implementation skills through tools and knowledge transfer
  • Approach:
  • Detailed Appraisal/Accelerated Implementation
  • Embrace and Integrate Previously Existing Initiatives
  • Duration:
  • 16 Weeks


  • Deliverables included workflow improvement, infrastructure building and enhancement of the training curriculum.
  • Development of aggregate and unit baseline reporting
  • Development of Claims and Customer Service staffing models and 'future state' models
  • Attainment of improved claims performance
  • Installation of Telephone Tiering in the contact centers
  • Development and documentation of infrastructure tools and ongoing reporting

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