Outsourcing Strategy and Implementation

Business Issue:

This client needed to prepare for a potential increase in the volume of paper claims received as a result of HIPAA, while maintaining compliance with service level agreements and simultaneously addressing excessive temporary and overtime costs.


  • Developed a customized approach to outsourcing that accounted for client’s needs, capacity for change, and technology capabilities
  • Led and managed the rapid “Proof of Execution” pilot, where claims processing began within 2 weeks, providing immediate benefit and freeing up in-house staff to focus on complex cases


  • Reduced the need to pay overtime to process claims
  • Implemented the client’s first-ever international outsourcing effort, creating a flexible, scalable workforce to assist in contingency planning
  • Monitored the ongoing delivery to ensure SLA’s were being met when processing more than 1 million claims annually, with over 99% Claims Payment and 98.5% Procedural Accuracy

Process Redesign and Change Management to define a flexible, scalable workforce for an East Coast Healthcare Payer

Let's Work Together

At Himes Consulting Group, we don’t believe we have all the answers. We know that the right solutions to improve your business come from conversation and collaboration. We have the experience to learn your business and partner with you to create process redesign programs that fit your team.