Health Plan Annual Benefits Readiness

Every year on January 1, modifications to government-sponsored benefit plans take effect. They affect the client’s ability to determine member eligibility, adjudicate claims and accurately process more than $1B in prescriptions a year.

Every independent project required for the 1/1 deadline had to work in unison, against a robust standard project methodology, to deliver “can’t fail” implementations on time and on budget.

• Reviewed 200+ projects across 27 assessment categories to objectively rank known and unknown issues and focus attention on the highest-risk areas

• Established the framework, practices and staffing for an Operations Center working with the enterprise Production Support Organization to detect, prioritize and resolve issues quickly

• Implemented an IT trouble-ticket tracking system for shift transitions, issue resolution and metrics reporting

• Supported supplementary regression testing of new system features and changes

• Shortened the time to resolve many 1/1 issues by more than 40% through project reference guides and playbooks

• Served as a bridge between business and IT while raising awareness of cross-platform issues and risks

• Identified best-practice opportunities to advance ongoing readiness, with lessons learned documented for future years

“What Digineer delivered was an absolute clutch (call it ‘game winning’) home run for Government Programs.”
Senior Director, Medicaid

Capability: Transformation & Value Management (Program Execution) · Industry: Health Insurance & PBM