Healthcare Industry
Customer Experience & Service Delivery, Operational Efficiency
Improving operational efficiency and service delivery through a modernized claims capacity planning model.
The Challenge
A leading health insurance company needed a more flexible and efficient back-office claims capacity planning model. The existing structure no longer aligned with how the business operated.
Key challenges included:
Claims volumes separated into silos across business lines, limiting visibility and flexibility
49 individual plans scheduled to migrate into a new model, creating a labor-intensive transition
An additional group with 11 new plans expected to expand the operational footprint and potentially require additional headcount
- Limited crossover visibility across plans, preventing identification of efficiency opportunities
Leadership needed a consolidated, scalable model that could support growth without increasing cost.
The Strategy
Northridge partnered with the client to redesign the claims capacity planning model around consolidation, transparency, and efficiency.
The strategy focused on:
Blending plan volumes across business lines to eliminate silos
Consolidating files to reduce operational complexity
Preserving full data representation while enabling cross-functional sharing
Designing a model that would support expansion without incremental headcount
The objective was to create a scalable WFM structure that increased analyst efficiency while reducing operational footprint.
The Execution
Northridge implemented a new blended claims capacity planning model that:
Reduced the number of managed claims files from 49 to 23, a 53 percent reduction
Enabled cross-business workload sharing and improved visibility into performance gaps
Identified and corrected configuration errors across three separate plans
- Integrated 11 additional plans from a new group into the model without adding staff
The redesigned structure improved collaboration across functions and removed inefficiencies caused by siloed planning.
The Impact
The new capacity planning model delivered measurable operational improvements:
53% reduction in claims file footprint
30% to 50% percent reduction in monthly analyst production time
Approximately 2 to 3 FTE headcount avoidance
- Improved functional coverage and workload balance
- Greater visibility into performance gaps and configuration issues
With a streamlined and scalable WFM model in place, the organization improved operational efficiency while reducing cost and strengthening service delivery performance.
experience + excellence
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