A large health plan had a severe backlog in reviewing records and determining pay denial of claims. Jacobson provided a team of work-at-home medical review nurses who worked through the backlog in less time than expected, completing the project two months early.
With healthcare reform deadlines approaching, this organization needed help developing and implementing new benefit plans and processes.
This health plan was in need of an experienced group underwriter to manage a major systems upgrade project. Jacobson quickly identified an organized, resourceful manager with nearly 30 years of leadership experience in group insurance environments to fulfill the client’s needs.
A health plan was struggling to pass the Center for Medicare and Medicaid Services’ audits. Jacobson’s expert was able to handle Medicare Part C and Part D grievances, complaints and appeals.
After a poor CMS audit, this health plan was in need of a consultant who could correct the problems and respond to CMS for a validation audit. Jacobson’s consultant utilized a background in Medicare compliance and CMS audit experience to quickly put together a corrective action plan.
This Blue Cross Blue Shield plan was not meeting CMS requirements and turned to Jacobson for a consultant who could improve policies and procedures and train the existing staff.
This nonprofit health plan was in the process of developing its underwriting department. At the time, its clerical staff and nurses were handling underwriting activities and had grown its inventory to 11,000 applications. Our consultants were able to quickly eliminate the backlog, setting the bar for the client as they recruited permanent staff.
When a large project’s due date was unexpectedly moved up two-and-a-half months, this client’s actuarial department was at capacity with workload. Jacobson quickly provided an expert with the functional, product and system expertise that aligned with the company’s needs.
A mutual life insurance organization was receiving interest from private exchange operators to partner and sell products through a more powerful channel. This insurer asked Jacobson to provide a consultant who possessed vast experience with health exchanges, co-ops and consumer-driven health plans, along with knowledge of healthcare reform, organizational development, strategic planning and nonprofit management.
To prepare for growth and a possible reduction in government funding, this large Medicare Advantage plan wanted policies, procedures, work flows, productivity and the claims department observed, as well as best practices/operating efficiencies presented.
This managed healthcare provider was focused on implementing a Health and Recovery Plan (HARP) to their product/line of business. Jacobson provided a healthcare professional with progressive experience in both the public and private sectors.
This health insurance captive third-party administrator was in need of an interim finance leader to assess the company’s financial processes and recommend improvements.