Evaluation and Trainings
Optimizing resources is the guiding principle for health plan SIUs.
Implementing Best Practices:
We have worked with clients to evaluate their effectiveness compared to their peers
and further deploy best practices beyond common challenges
such as heavy workloads and emerging schemes.
Problem
A medium-sized health plan required:
– An independent assessment of their SIU that extended beyond the classic way of benchmarking SIU performance.
– Training based on findings.
Solution
We created a unique assessment that compared real data of the client to other clients with the same lines of business. After delivering the final report, we provided an onsite 4 day exclusive training to the entire SIU team and continued with ongoing quarterly training sessions.
Outcome
Our assessment created a business case for the SIU team to receive more funding. We delivered training with 3 retired HHS-OIG special agents who have experience with both commercial health plans and UPICs to provide best-practices investigator training.
Effectiveness includes:
Integrating
Provider and Claim Reviews
Seamlessly merging provider and claim-level investigations to gain a comprehensive understanding of potential fraud or abuse patterns.
Implementing
Prepay Waste and Abuse Pattern Reviews
With the increasing use of technology, there is a growing need to incorporate unique human expertise to understand the nuances and context of FWA.
Cultivating
Talent Acquisition and Retention
Ensuring the recruitment and retention of skilled professionals with diverse expertise to maximize investigative outcomes.
Capitalizing
Collaborative
Partnerships
Leveraging partnerships with fellow payers and internal stakeholders within health plans to drive value through shared intelligence and resources.
Leadership, growth, and company development are areas about which we are passionate. As part of our commitment to continuous improvement, we focus on instilling consistency and a detail-oriented mindset.
Our Approach
We offer actionable intelligence and immersive exercises. Our training encompasses:
– Scenario-based simulations,
– Case studies,
– And collaborative workshops replicating real-world challenges.
Contact us today to explore how our trainings will drive your team’s growth.
Don’t just build a thriving business—
build a thriving team.
Integrate best practices, maximize resources, and drive impactful results.