Claims management for a large health insurer in USA

Qantev helps one of the top 10 Health insurers on the East coast increase their straight through processing rate

This insurer, based in Miami, offers a comprehensive range of health insurance plans tailored to meet diverse needs. They focus on providing access to high-quality medical care, including preventive services, specialist consultations, and hospital treatments. With a commitment to customer satisfaction, this insurer ensures policyholders receive timely and efficient support. Their plans are designed to offer financial protection and peace of mind, making them a trusted choice for individuals and families seeking reliable health coverage. They have chosen the Qantev platform to streamline their operations, save costs, and improve customer experience.

The insurer is facing challenges in order to reach its ambitions, mainly caused by the reliance on non-flexible legacy systems, causing processes to be manual.

• Large majority of claims processed manually
• Lengthy claims turnaround time
• 8% estimated leakage from fraud, waste and abuse
• Impacted by medical inflation

They have chosen to adopt the Qantev platform to overcome their challenges and set the stage for their digital transformation, fully deployed and operation within 6 months

• Deployment of the Qantev claims management module 
• Deployment of  the Qantev fraud, waste and abuse  module
• Deployment of the Qantev OCR & data acquisition module

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Qantev has enabled this insurer some rapid and tangible business results

• 45% straight through processing rate achieved in 12 months
• 90% of data acquisition processes automated
• 2% reduction in total costs of operation
• 40% reduction of the average turnaround time
• ‍Positive ROI after 4 months of production