Top 3 U.S. Health Insurer Finds Newfound Capacity with Standardization

Membership administration seeks process mapping and automation opportunity discovery

The COO at a Top 3 U.S. health insurance provider sought to improve production throughout her organization. Using her Wall Street background, she identified seven categories of waste she sought to reduce or eliminate. These included: “Defects” (i.e., improper submissions), excess processing (rework), unnecessary wait-times, avoidable motion, and others.

Key to eliminating the specific problems was pinpointing them. With the COO of Membership Administration as its sponsor, this health insurance provider reached out to The Lab, North America’s respected authority for end-to-end (E2E) process mapping and automation discovery for knowledge-work activities.

The project scope was broad. It encompassed corporate, institutional, and individual plans, including Medicare and Medicaid. Specifically, the COO wanted to identify and convert all one-off methods into standardized work modules. Only then could proper work sharing begin—along with capacity planning that wouldn’t suffer from volatility spikes, an essential consideration in today’s labor-tight market.

And so, in order to pinpoint the bottlenecks, opportunities for robotic process automation (RPA) bots, and “the seven wastes,” the first order of business for The Lab was E2E process mapping of all activities within membership-administration operations and its 1,300 employees. With minimal time commitments required of sponsors, staffers, and subject matter experts (SMEs), The Lab was able to complete the entire E2E process mapping in just seven weeks.

Standardization in the spotlight

With the process maps in hand, The Lab was able to identify—and ultimately implement—300 improvements. While RPA (“bots” that sit at the computer handling repetitive, error-prone chores) is a minimally-invasive technology which leaves core systems intact, many of the benefit opportunities identified by The Lab for the membership-administration operation required no new technology whatsoever. Examples include:

  • Process standardization for capacity planning. Analysis by The Lab revealed that while membership-administration teams were specialized by plan type, the characteristics of the different plans themselves were 80 percent similar. The unnecessary layers of “specialization” resulted in complex capacity planning. A substantial 25 percent of wait time—one of the “seven wastes”—could be traced to this issue alone. New, standardized work definitions helped to reduce specialization and led to standardized capacity planning. Wait time was virtually eliminated.
  • Inbound logistics: Reduction of data “defects.” Here’s an eye-opening finding that resulted from the E2E discovery: Roughly three percent of plan sponsors generated about 75 percent of the errors from inbound logistics for data transmittal. This glaring “defect” of inbound errors was quickly identified and rectified. The Lab helped membership-administration teams and plan sponsors to jointly conduct business-process reengineering for data transmittal. As a result, the inbound error rate was slashed by 90 percent.
  • Improved capacity management. All membership-administration teams were staffed, year-round, for the peak demand that only happened at one time of the year: Open enrollment. Consequently, precious worker capacity was effectively being squandered most of the year. The Lab’s Activity Cube model capitalized on simplified teams and standardized processes to forecast workloads. It measured productivity all the way down to the individual-employee level. As a result, capacity increased 30 percent in just three months.

“Bot-ified” opportunity

Far too many of the membership-administration teams’ chores were spent doing mindless, repetitive, and error-prone activities, such as copying data (field-by-field) from one system to another (since the systems don’t talk to each other), and performing tedious reconciliations of data—that is, the dreaded “stare and compare” activities to make sure that data from disparate systems line up and match.

These chores, and countless others like them, are ripe opportunities for robotic process automation or RPA. An RPA “bot” can “sit at a computer,” just like a person, and perform these same activities at lightning speed, without ever slowing down, taking breaks, or making mistakes.

Contrary to some misinformation out there, knowledge workers aren’t threatened by bots like these. Given the tight market for talent, these people want to focus their skills on high-value activities… and hand off the chores to the bots. Thus automation—as identified at the activity-level in maps from The Lab—aids in employee retention, too.

A raft of benefits for this Top 3 health insurer

The initial E2E process mapping and automation discovery was conducted by The Lab in just seven weeks. Our offices are in Houston, and we work remotely, with nothing outsourced or offshored, ever.

Given all of the benefits identified in the analysis-and-mapping phase, this U.S. Top 3 insurer retained The Lab for the implementation of its findings, which was completed in just six months. The results of this implementation are impressive; they include:

  • Capacity improvement of 35 percent.
  • Inbound error rate reduced by 90 percent.
  • Operating costs reduced 25 percent.
  • Annual savings: $26M.

The self-funding project broke even in just four months. Twelve-month ROI was fivefold.

Book your free demo

The best way to appreciate this speed and game-changing power is to see it for yourself. We invite you to schedule your free, no-obligation 30-minute screen-sharing demo with The Lab. You’ll see real RPA banking bots in action, and get all your questions answered by our friendly experts.

Simply contact The Lab today at (201) 526-1200 or email us at to book your free screen-share bot demo.


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