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US: Health Insurance Operations

Client: Leading regional health insurance provider

Insured Premiums: $8B

Role: Process Design and Operational Planning Consultant and Project Leader, as a consulting subcontractor

Description: Led a process design and operational planning project whose objective was to provide an actionable operational plan for a mission critical IT function in the organization. New support systems were being developed, but operational planning had not kept pace with the technological and process changes that resulted from these new systems. New processes needed to be defined and documented that interacted with existing baseline processes in the rest of the organization. An operational plan was required for the department charged with the management and maintenance of these new systems to ensure that organizational objectives for those systems could be achieved in accordance with demanding implementation timetables. The resulting operational plan that was presented to and accepted by senior leadership incorporated detailed inter-departmental process flows and touch-points, critical controls, organizational design changes, and definition of the new roles, qualifications and responsibilities of the participants under the new department organizational model.

Outcome: In less than three months, a departmental operational plan was developed whose details and recommendations were approved by the department itself and by those departments that were impacted by the changes. Internal audit reviewed and strongly approved the enhanced controls that were incorporated in the plan.

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