Case study: $5 Billon Contract Win

Health Insurance


State contract ends in one year and the State will be going for out for bid. The contract represents $1 Billion in annual revenue.

State Line of Business represents 20% of Membership, loss of

this magnitude has remaining 80% of business absorbing shared services costs,

likely requiring layoffs.

Need to reduce the operational costs by $2,450,000 annually.


The Business: Analyzed Financials. They uncovered $700,000.

Me: Utilizing Value Stream

Mapping techniques to uncover

opportunity that Financials simply could not - Promised a solution in three


When a business does not deliver correctly the first time,

rework occurs.

The old process:

·        The customer

has to call in to request the issue be resolved

·        Customer

Service First Call Resolution (FCR) was 85%

·        15% of issues

were passed onto other departments to solve and report back. These issues were communicated

by a Customer Service (CS) person in a different language than what a Claims

person would understand, and  documented by CS in one system and passed to

another department in another system or via email.

The company had been in business for over 75 years. They could

not recognize the fact that there were whole sub-departments that did nothing

but address issues (performed rework).

1.     Eliminate entire rework loop

2.     Retired the rework workflow


3.    Dedicated claims experts to Customer


4.     Added 2 fields in CRM to capture

root cause



100         Customer Service Representatives               80

10,500    Monthly Call Volume                                    9,800

85%        FCR* Rate                                                         97%

17           Dedicated Claims Personnel                         8

50%        Claims Resolved  < 7 days                             90%

5             Membership FTE                                             1

1             IT FTE                                                                0

2             Workflow Systems                                          1

$1,600,000 in annual savings

Bid Won! - $5Billion contract!


In the old world, Customer Service Reps and Claim Professionals were not encouraged to communicate to each other. Customer issues were thrown over the wall (and back) with minimal interaction, little to no knowledge-transfer, and limited understanding of root cause.

I was delighted to see a very detailed Instant Message (IM) between a Customer

Service Rep and Claims Professional on July 20th. The Claims Professional had responded that the claim had processed correctly based upon the  procedure. The Customer Service Rep shared a link - an important proc