Offshore
- 32% — “No Action Required” claims
- 21% — manual Excel tracking
- 7% — reviewing notes, messages and errors
- 6% — looking up member information in a second system
- 4% — manually adding notes
Anonymized analysis · Global Health Insurance Company
69% offshore FTE savings opportunity identified in Medicare claims processing.
Stereologic analyzed 3,053 claims across 107 claim subtypes spanning onshore and offshore Medicare claims-processing operations, and tied the improvement opportunity back to specific activities, systems and process behaviours rather than a single unexplained efficiency estimate.
69%Offshore FTE savings opportunity identified
35%Onshore FTE savings opportunity identified
+5claims/hour offshore throughput opportunity
+1.5claims/hour onshore throughput opportunity
How to read these figures. These are identified opportunities, not realized savings. The 69% figure applies to active time only; active time represented 65% of total time, so it does not represent 69% of total employee time. Throughput figures are modelled opportunities. Customer anonymized at their request.
The situation
High process diversity, offshore operations, and limits in the core systems.
The operation included more than one hundred claim types across onshore and offshore teams. The engagement focused on three challenges: a large employee population with high process diversity, the presence of offshore operations, and functional limitations in the main business systems.
The goal was to accelerate claims processing and reduce cost by identifying where time and capacity were being consumed across the operation.
Scope
What the engagement covered
- Two teamsOnshore and offshore.
- 3,053 claims, 107 subtypes81 within Professional claims, 26 within Institutional claims.
- Detailed analysisApplications, activities, processing outcomes and units per hour.
What Stereologic analyzed
- Employee recordings
- Applications and screens in use
- Time measurement for each activity
- Claim-processing scenarios and units-per-hour analysis
- Process maps and process documentation
- Savings and improvement-opportunity analysis
What Stereologic found
Recurring sources of avoidable effort — and one that dominated.
Employees were manually tracking claims in Excel, recording claim activity in a second system, reviewing claim notes, messages, warnings and errors across multiple screens, looking up member information outside the primary system, and manually adding notes.
The finding that mattered most
37% of offshore claims were classified as “No Action Required”, accounting for 32% of offshore active time — primarily because those claims had already been processed before reaching the worklist. Work was being performed on claims that needed no work.
The analysis also showed substantial variation in units per hour across individual employees and between the onshore and offshore teams.
Where the opportunity came from
Tied to specific activities, not to a single efficiency estimate.
Identified active-time opportunities, by team.
Onshore
- 11% — Excel tracking
- 9% — tracking in a second system
- 6% — reviewing notes and messages
- 4% — “No Action Required” claims
- 3% — manually adding notes
- 2% — looking up member information
Throughput
Modelled throughput opportunity
| Team | Current | Modelled | Opportunity |
|---|---|---|---|
| Onshore | 9.5 claims/hour | 11 claims/hour | +1.5 claims/hour |
| Offshore | 7.2 claims/hour | 12.2 claims/hour | +5 claims/hour |
Improvement actions identified
What the evidence pointed to
- Creating workflow functionality in the core claims platform for offshore staff
- Automating extraction of productivity reporting
- Rationalizing duplicate tracking and notes
- Centralizing important claim messages and warnings
- Improving the connection between the claims platform and the member-information system
- Automating claim-note generation
- Preventing already-processed claims from returning to employee worklists
Project timeline
Five weeks, end to end
Week 1 — Plan and prepare
Select processes, collect intake information, onboard management, instruct employees and deliver the process walkthrough.
Weeks 2–4 — Record and analyze
Record employee work, conduct process discovery and diagnostics, and generate process maps, time measurements and other project artifacts.
Week 5 — Report and present
Prepare the final report, present findings and submit the final package of deliverables.
What the engagement delivered
Activities and system interactions, connected to specific opportunities.
Instead of relying only on aggregate productivity measures, the analysis showed where time was being consumed, which activities were creating avoidable work, how processing varied across employees and teams, and where targeted process or system changes could recover capacity and increase throughput.
Method and limits
What these figures are, and what they are not.
- The 35% and 69% figures are identified FTE savings opportunities, not realized post-implementation savings.
- The 69% offshore figure applies to active time only. Active time represented 65% of total time, so it is not 69% of total employee time.
- The throughput figures are modelled opportunities.
- The customer is anonymized. No detail that would identify the operation is published.
Source: Stereologic’s Medicare claims review case study and the accompanying claims-processing optimization summary.
Take the next step
What would a subtype-level analysis find in your claims operation?
Bring one claims process and the throughput or cost number you are being asked to defend. We will explain what would become measurable, and what a defined scope would require.
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