Insurance network implements SaaS platform to facilitate growth, decrease manual processes

Client background

The company is a network of dental insurance companies operating in all 50 states, Washington D.C. and Puerto Rico.

The business challenge

The company needed to modernize its core administration platform as their current legacy system was outdated and unable to meet the company’s evolving needs, prompting a desire for a more efficient SaaS platform to facilitate growth and decrease maintenance costs. Additionally, the company was looking to improve their claims adjudication rates by eliminating their current manual processes and introducing automation, where possible, to improve efficiency. The company needed a technology solution that could centralize and support all payer business capabilities, ensuring a streamlined operational framework.

However, the company lacked a robust corporate structure to support such a large-scale implementation and engaged Baker Tilly to help.

Strategy and solution

Baker Tilly worked with the company to determine the best approach to their system implementation needs. Beginning with a planning phase to define success criteria and mitigate implementation risk, we supported the company in defining their business case, selecting a platform that best suited their needs and introducing an organizational change management methodology that built platform specific training, properly communicated the incoming changes and identified incentives needed to motivate the teams through the long implementation cycle.

The subsequent blueprinting phase allowed Baker Tilly to assess the company’s current-state business workflows and technology landscape to define and document process workflows for each functional area that was being converted and map out desired future state workflows. During the system implementation process, we tracked and managed all aspects of pre-defined workflow configuration and testing to ensure issues were identified, documented and resolved prior to go-live.

Lastly, we provided Hypercare and sustainability support to address and correct any issues that arose post go-live. This included providing a workforce to support future platform releases and prioritize optimization activities around the platform to ensure the data environment remains healthy.

As a result of this engagement, the company successfully converted to their new platform, allowing them to continue to expand their geographic footprint and take on new customers as well as:

• Replace an obsolete platform
• Move to buy vs. build operation model through a SaaS platform vendor, enabling a more agile and efficient IT operating model
• Improve claims auto-adjudication rates and payment accuracy, decreasing the volume of claim manual review