Medic Outsourcing Claim Analysis

Decent Essays
Due to Medica exiting the Medicaid Program marketplace. My organization Hennepin Health membership is expected to increase by at least 20,000 recipients. The adaptive challenges, my organization continuously faces is a delay in claims payment from our vendor TMG. An increased membership will result in an overflow of unresolved claims issues. The most difficult, challenge is we assigned new processes, due to an individual’s lack of claims knowledge or someone enhanced skilled sets. Eventually there will be over flow of unresolved claims issues like before. An adaptive challenge for me, is we never fixed delayed claims issues. This is a reoccurrence effect of a internal barrier for outsourcing claims. The most difficult challenge for me is

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