Case Study: Healthcare Insurance Enterprise

• Receive millions of pieces of USPS and fax mail monthly

• Government regulations around Medicare and Medicaid stipulate contractually required SLAs

• Mail volumes fluctuate during open enrollment, creating staffing challenges

• High volume of return mail due to bad addresses and inactive members

• Lacked automated processes and reporting

As a large healthcare insurance payer, inbound and outbound communications — typically mail, both physical and electronic — are a critical part of the business. About 40% of mail is received as physical mail through United States Postal Service (USPS) post office (PO) boxes compared to 60% that is received electronically as live mail, most of which are faxes.

Undeliverable-as-addressed (UAA) mail can’t be delivered as addressed and must be either forwarded to the addressee or returned to the sender. With millions of members and frequent outgoing communications, the healthcare insurance enterprise has a staggering volume of returned mail.

The health insurance payer used two ways to update addresses: National Change of Address (NCOA) and Proprietary Change of Address (PCOA) services. NCOA checks for a new address, at a high level, based primarily on individuals who have registered a change of address with USPS while PCOA checks additional databases for better addresses, often associated with utility companies or other records. Updating addresses is not only contractually mandated but it’s more profitable for the company because sending less undelivered mail could save them millions of dollars annually.

The insurance payer also handled a high volume of “live mail,” which includes inbound mail from post office boxes, accountable mail, emails and faxes. The contractual SLAs for end-to-end processing are very aggressive and part of client contracts so they must adhere to them.

Additionally, integration with other applications, automated workflows, AI tools, and reporting was minimal, so the company looked to improve in these areas. They sought a better way to redact and split mail pieces from providers who submit documentation with multiple values listed and streamline electronic and USPS receipt methods.

Staffing challenges prevailed and finding workers for both regular shifts (many employees no longer wanted to work in an office) and temporary positions during the enrollment busy season was difficult. Having industry-wide peaks and valleys limited a steady workforce.