Customer Service and Claims

Cigna Tech

Cigna is an insurance company in the United States that has faced its share of financial hard times due to the increased government regulatory environment and competition from its competitors. Although the company is the fourth largest insurer in the United States, it has faced its share of financial difficulties. In 2002 the company reported a $500 million dollar net loss for the year which resulted in a 40% drop in equity value. The company stock was not the only thing getting hammered that year, the company was also under pressure from doctors who were suing the company due to late reimbursements.

The problem facing Cigna was a threefold dilemma. First of all, was the above mentioned lawsuit by doctors who contended that Cigna was purposefully withholding and/or delaying payments for reimbursements and patient care. The doctors were not at all happy with Cigna (and other insurers) accusing the insurance companies of deliberate misconduct regarding the payment of claims.

Secondly, Cigna's sales personnel had made a number of promises to clients regarding the implementation of new technology that would vastly increase customer service and accessibility to data. The need for this technology was obvious not only to Cigna, but to its customers as well. The new EC system would not only provide improved customer service but would also supply customers with up-to-date information and tracking services. The problem was that the sales personnel had made promises that were not being kept. The system had yet to be developed, and Cigna was under pressure to complete the system's implementation.

Last but not least were the company's stock and financial woes. The company had posted disappointing earnings, huge losses, high expenses and lower revenues. Cigna executives were anxiously awaiting the implementation of the new technology since it promised effective cost reductions and corresponding productivity gains.

The Solution

To solve Cigna's technology problem a solution was proposed that took a two-pronged approach. Cigna wished to update and consolidate its Information Technology (IT) systems and in order to do so wished to create a system that would allow for customers to receive one bill for medical services that was processed in a timely and efficient manner. Claims would be processed in a more timely fashion and customers would be able to track the claim from submission through payment. Customer service representatives would be capable of viewing the claims and the claims would be unified with other services and claims submitted by the same client. The unified view would allow for prompt assessing and modification by customer service when contacted by the customer.

To achieve its goals, Cigna implemented a consolidation of all its IT systems. There were two integrated systems; one system was to be used for verifying the eligibility of the submitted claims, the second was for billing. The IT group was charged with building an infrastructure that could support two integrated systems. To assist in this endeavor, Cigna hired an outside firm; Cap Gemini Ernst & Young (CGEY). CGEY's responsibilities included assisting in the implementation of management and business processes. CGEY also developed and implemented the customer-facing applications. These applications allowed members the ability to enroll, track their claims, check their benefits and select from a variety of options regarding health plans. Customer service representatives would also benefit from the new technology; they could now access all client information from a single screen, providing customer service with a clear and concise summary of the customer's history with the company.

Application

The results were tremendous although there were still some glitches that took nearly six months to overcome. The process of converting from the old system to the new system took literally minutes to accomplish. Three and a half million members were switched from the previous 15 systems to the new two-system approach. Using the new two-system approach has alleviated many of the former problems experienced by Cigna, while at the same time providing a higher level of proficiency and cost savings. Customers can now track and submit their claims online, check the status of their submissions, discuss issues with online nurses and make a number of healthcare related decisions. Previously these capabilities were non-existent.