Insurance network improves CX with standardized EDI processes
Insurance network develops internal tool for plan member enrollment and eligibility electronic data interchange files to standardize client experience and internal processes.
Client background
A member organization of a network of dental and vision coverage operating in all 50 states, Washington D.C. and Puerto Rico.
The business challenge
As the insurance organization grew and took on new customers, they were able to set up one-off special handling rules to accommodate non-standard eligibility files because they owned the source code for their system. Over the past 5 years they have been modernizing their business and have transitioned from their legacy system to a new claims and benefit administration platform.
As the organization mainly does group business, they don’t receive unique member identifiers on incoming Electronic Data Interchange (EDI) files. Their new administration platform relied heavily on unique identifiers and required the introduction of custom lookups and member matching logic for the client to be operational. While this was an acceptable solution in the short term, the organization continues to struggle with properly identifying members and creating duplicate member records in their system. This reliance on custom logic has led to increased cost and manual work for the company.
