National Healthcare Payer

Empowering a national healthcare payer to work smarter

What We Did

Many healthcare payers are overwhelmed with time-draining back-office operations — and as a result they’re always running at full capacity. So when a major national healthcare payer launched a $15 billion enterprise cost reduction effort, it turned to West Monroe’s cross-disciplinary team to address the challenges holding them back from next-level efficiency.


savings in labor costs


annual benefit


process improvements

The Opportunity

When a large national healthcare payer undertook a $15 billion cost reduction initiative, it faced a difficult dilemma: How to reorganize its back-office provider support network to better align with workload while maintaining best-in-class service levels.

But this challenge also posed an opportunity to work smarter and serve better. The healthcare payer teamed up with West Monroe to:

  • Empower productivity
  • Reduce unnecessary labor
  • Free up capacity for high-value initiatives

An Undeniable Approach

Drawing from deep experience in health plan operations and technology, our cross-disciplinary team knew the solution would be in the details. So we got to work:

  • Observing: Through workshops, stakeholder discussions and over 500 hours of job shadowing, our team qualitatively mapped workflows and responsibilities for each role
  • Analyzing: We then got quantitative, using statistical analysis on task-level data to determine high-impact activities and define role-based expectations
  • Optimizing: During our observation and analysis we uncovered over 100 process improvement opportunities
  • Training: Finally, we trained client teams through a series of small focus groups, town hall meetings, and QA sessions with leadership and staff

The Output

Our resource capacity planning solution delivered calculated the required hours and full-time equivalent resources by department, allowing the client to reallocate people in response to work volume changes. Each model is based on predictable—and trackable—service demand drivers like call volume, number of doctors added to the database, and errors requiring research, meaning the healthcare payer could live up to its customer service reputation while reallocating business resources when needed.

Returns You Can Measure

A project like this is only meaningful when it translates to real business value. Our collective work delivered:

  • 20% lift in productivity—that allows the client to redistribute people and resources toward value-adding projects
  • $8 million in annual savings through process improvements—including streamlining operations and deploying robotic process automation
  • 100+ additional process improvements identified to yield additional savings

Doctors Working

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