With decreasing budgets and increasing costs, managed care organizations must transform their business in order to succeed in this competitive arena. To help organizations achieve this change, KHL Consulting Services leverages its deep expertise of operational interoperability and data to help clients understand their current state of operations and how best to optimize internal processes.

Operational Performance & Service Delivery

  • Process Documentation
  • Root Cause and Impact Analysis
  • Process Redesign

Operational Analytics 

  • Diagnostic Mining
  • Analytical Insights
  • Management Reporting and Scorecards

Representative Experience Includes:

  • Defined and resolved issues related to membership eligibility, benefit configuration, claims processing, provider billing, provider and benefit contract loads, claims data entry, prior authorizations, referrals, coordination of benefits, etc.

  • Analyzed large volumes of claims and/or member data to identify deficiencies in systems and/or processes

  • Conducted process improvement assessments resulting in short-term and long-term recommendations and implementation roadmaps