While the new year and new leadership in the White House may brighten the outlook for some sectors of the economy, the health insurance industry is expected to continue to struggle in 2017 with the cost burdens of the Affordable Care Act (ACA).
Health insurance exchange customers have continued to be sicker (and, hence, higher users of services) than predicted. Meanwhile, many healthy people have opted out of the exchanges, discouraged by high premiums and high deductibles. A number of health insurance companies have cut their losses and pulled out of the exchanges, leaving only one carrier participating.
Given these conditions, insurance rating service A.M. Best is maintaining a negative outlook on the U.S. health insurance sector through 2017. Although President-elect Trump and a Republican-controlled Congress have vowed to repeal or replace the ACA, A.M. Best analysts don’t expect any significant changes to the insurance market until 2018.
The pressure to reduce costs and maintain or regain profitability has health insurance companies seeking a competitive advantage by outsourcing non-core business functions to outside service providers.
Business process outsourcing (BPO) providers such as DATAMARK have offered these kinds of business services for years now, reaching a level of maturity that consistently delivers cost savings, efficiency and other added value to health insurance providers.
BPO services used by the health insurance industry include, but are not limited to:
- Administrative services, such as marketing and sales, finance and accounting and procurement and supply chain.
- Member management, such as account creating, eligibility and enrollment, billing, benefits management and customer service through multichannel contact centers.
- Claims administration, such as adjudication and processing, and complaints and appeals.
Additionally, BPO service providers are delivering value beyond transaction processing. A mature service provider like DATAMARK, with more than two decades of experience servicing health insurance industry clients, serve as consultants as well. For example, DATAMARK’s Business Engineering team is tasked with driving inefficiency out of clients’ processes using a combination of business process improvement methodologies and, where applicable, automation.
To learn more about DATAMARK’s service for the health insurance sector, contact us today to speak with one of our business process improvement specialists.