Health Plan Cuts Claims Turnaround Time While Reducing Processing Labor
Administrative drag removed during rapid membership growth—improving service levels and cost structure simultaneously.
Organization
Southern California health plan experiencing record membership growth.
Engagement Intent
Reduce claims processing cycle time and labor intensity while maintaining quality and predictability.
Growth exposed a throughput constraint
Membership growth increased claims volume and strain on processing capacity. Turnaround time became unacceptable, creating service risk and cost pressure.
Leadership prioritized speed and cost structure
Leadership engaged EMS to reduce administrative drag and restore reliable claims throughput—without adding complexity or dependence on temporary fixes.
Faster processing, lower labor burden
- ✓
50%+ reduction in steps and labor involved in claims processing
- ✓
Turnaround time reduced from 6 weeks to under 2 weeks for 95%+ of claims
- ✓
Material cost savings driven by simplified work and reduced rework
- ✓
Improved predictability and service performance at higher volume
Company name withheld by design.
Service improved without adding headcount
The organization improved service levels and reduced processing burden simultaneously—creating capacity for growth while strengthening the operating cost structure.
No sales pitch. We’ll determine quickly whether there’s meaningful value to create.
EMS Consulting Group works with senior leaders to improve enterprise performance, reduce strategic risk, and build internal capability for sustained results.