Streamlining insurance operations, accelerating claims processing, and improving operational visibility through a scalable platform built to support nationwide growth across all 50 US states.
Faster ACD processing turnaround
Claims backlog cleared in under 2 months
Nationwide operational expansion achieved
A mid-sized US health insurance and TPA provider partnered with Shivohm to improve operational efficiency, modernize internal systems, and enhance member experience across departments.
The goal was to streamline membership management, claims processing, customer support, and financial operations through a centralized technology ecosystem.
The client faced multiple operational and system-related inefficiencies that impacted service delivery and scalability.
Legacy platforms like Navigator and Salesforce operated independently without integration, creating data silos and workflow inefficiencies.
Membership management, invoicing, and ACD workflows relied heavily on manual operations, leading to delays and inaccurate data handling.
Members had access to only one overloaded support channel with no self-service capabilities.
The organization faced an $8.4M claims backlog with payout timelines extending up to 45 days.
Financial tracking was managed through spreadsheets, limiting visibility and operational control.
A centralized operational transformation strategy was implemented to modernize systems and streamline workflows.
A unified platform, Navigator2 (Nav2), was developed to centralize operations across teams and departments.
Data from Navigator, Salesforce, and spreadsheets was migrated, cleaned, and structured into centralized reporting systems.
A member mobile application was launched to provide access to plan details, ID cards, and support tracking.
Automated roster updates and workflow improvements accelerated claims processing and cleared the operational backlog.
We integrated Nav2 with multiple enterprise platforms to create a connected insurance operations ecosystem with centralized workflows, real-time data synchronization, and improved cross-department collaboration.
We integrated Nav2 with multiple enterprise platforms to create a connected insurance operations ecosystem with centralized workflows, real-time data synchronization, and improved cross-department collaboration.
Requirement analysis and roadmap development.
Custom platform development and enterprise system integrations.
Platform deployment, migration execution, and operational rollout.
Continuous maintenance, optimization, and long-term support services.
Claims processing timelines improved from 45 days to 7 days.
An $8.4M claims backlog was cleared in less than 2 months.
Centralized systems improved communication, reporting accuracy, and workflow transparency across departments.
Rejected claims reduced by 49% through better tracking and follow-ups.
The client successfully expanded operations across all 50 US states.
Enhanced support channels and mobile access improved overall customer engagement and service delivery.
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