Healthcare Industry
Customer Experience & Service Delivery: WFM Capacity Planning Redesign
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
Ready to Align Your Organization
for Growth?
Across highly regulated and complex environments, we partner with organizations to elevate quality, strengthen compliance, and drive measurable performance improvement through disciplined monitoring, analytics, and capability building.
Connect with a Northridge Expert
Case Studies / Contact Center Management
WFM Capacity Planning Model Helps Leading Healthcare Insurance Company Reduce Claims Capacity Planning Footprint, Increase Analyst Efficiency, and Save on Headcount Expenses
Healthcare Industry
Challenge
- A leading health insurance company needed a new back-office claims capacity planning model that was flexible and efficient. The existing model no longer aligned with the way the business was managed and was inefficient to operate. Plan volumes for their different business lines were separated into distinct silos that didn’t account for the crossover between the individual plans.
- The main claims group had 49 individual plans that they planned to migrate to the new model, a labor-intensive process.
- An additional challenge was that the business footprint would have to be expanded to include another group with 11 additional plans which could require additional headcount.
Approach
- Northridge partnered with this client to build a new Claims capacity planning model that consolidated plan volumes so that gaps and opportunities could be easily identified and remedied.
- The new blended model reduced their file footprint for Claims (the number of plans they manage) from 49 to 23, a 53% reduction.
- All data was still represented, but the new blended format allowed sharing across businesses, resulting in a ~50% increase in analyst efficiency. Since the volumes were no longer siloed, it was easier to identify and resolve gaps and opportunities, leading to further efficiencies.
- The reduction in files and combining of resources among business lines allowed the client to add the 11 plans from the additional group without adding any headcount, a savings of approximately 2-3 FTE.
Business Impact
- Benefits of the new back-office claims capacity model included:
- Reduced file footprint for Claims by 53%
- Reduced monthly production time for analysts by 30-50%
- Installed additional group’s plans without additional headcount
- Exposed and corrected previously unknown errors in file configuration on 3 separate plans
- Aligned functions allow for more effective coverage
- Quantified previously estimated gaps for new group
- Avoided the cost of implementing the new group into the previous model (at least 28-30 files and additional ~2 to 3 FTE)
Connect with a Northridge Expert
Let’s Talk About Your Organization
With experience across nearly every industry, non-profit and governmental agency, we have the team to help you grow.
