CASE STUDY · HEALTHCARE CLAIMS OPERATIONS

Most health plans don't have a claims processing problem.They have an operational intelligence problem

 

Learn how a Regional Midwestern Blues Plan reduced claims inventory by 69% in just eight weeks by giving operations leaders real-time visibility into every claim

69%
Backlog Reduction in 8 Weeks 
40%
Faster Operational Decisions  
8Wks
Time To Measurable Impact
✓
HIPAA Certified
★
Trusted by Leading Payers
✓
99%+ Accuracy
✓
15M+ Claims Adjudicated Annually
✓
20M+ Frontend Claims Processed annually

The Business Challenge

Claims were managed across multiple systems and manual tracking processes, making it difficult for leadership to identify bottlenecks, forecast capacity, or intervene before SLAs were impacted.

Growing Claims Backlog

Rising claim volumes outpaced processing capacity, causing aged inventory to accumulate and SLA timelines to slip.

No Lifecycle Visibility

No centralized mechanism tracked claims from generation through completion, leaving leaders blind to claim status and ownership.

Hidden Bottlenecks

Manual tracking made it nearly impossible to identify delays until service levels were already impacted too late for proactive intervention.

Reactive Capacity Planning

Workforce planning relied on hindsight, with no data-driven forecasting to align staffing with incoming claim demand.

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THE MDI SOLUTION

 MDI implemented a real-time operational intelligence platform that provided end-to-end visibility, workflow governance, and predictive capacity planning  

1

End-to-End Claims Visibility 

Every claim tracked in real time from generation through final completion, across all processing stages and exceptions.

2

Unified Operational Control 

Unified environment to monitor queues, aging inventory, and stalled claims eliminating manual tracking entirely.

3

Real-Time Executive Insights 

Role-based InsightPro dashboards surfacing backlog, receipts, SLA adherence, and team productivity in one view.

4

 Predictive Workforce Planning 

Receipt trends and throughput data enabled proactive staffing decisions and workload balancing across functions.

5

 Proactive Bottleneck Detection 

Advanced reporting pinpointed delay stages, workload imbalances, and recurring exceptions with root cause analysis.

6

 Operational Governance 

Daily reviews, automated alerts, performance scorecards, and executive dashboards created structured accountability.

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BUSINESS IMPACT

69%

 Reduction in aged inventory Lower administrative costs

40%

 Faster decisions Better workforce allocation  

20K → 6K

 Higher throughput and stronger SLA performance  

Claims Inventory Improvement 

8-Week Implementation Results

20,414
 
Wk 1 ---
17,352
 
Wk 2 ▼ 15%
15,617
 
Wk 3 ▼ 10%
12,650
 
Wk 4 ▼ 19%
10,879
 
Wk 5 ▼ 14%
9,464
 
Wk 6 ▼ 13%
8,045
 
Wk 7 ▼ 15%
6,275
 
Wk 8 ▼ 22%
Inventory Count Weekly Progress Final Result Weekly Reduction %

Claims inventory fell from 20,414 to 6,275 — a 69% reduction in eight weeks of implementation.

STRATEGIC OUTCOMES

Operational Excellence

 Real-time visibility across claims operations. 

Executive Control

 Faster, more informed decisions. 

Greater Scalability

 Supports growth without added complexity. 

Reduced Risk

 Improved SLA and inventory management. 

Workforce Optimization

 Better resource planning and utilization. 

AI Foundation

  Prepared for intelligent automation.

10740 Nall Avenue, Suite 100, Overland Park, KS 66211