🔍 Turning Complexity into Capability

Supporting Post-Acquisition Integration for a National Health Plan

Following a recent acquisition, our client, an established health insurer, faced a significant challenge: they needed to integrate and expand their existing product portfolio to support both current claims processing and claims runout for a period extending two years post-transaction. With over 450 plan designs inherited and an accelerated timeline, it was clear that a conventional approach wouldn’t suffice.

Despite having fewer than three internal resources and needing to rely heavily on external partners for source data and benefit requirements, we quickly mobilized a strategy to bring clarity and structure to a highly complex situation.

Challenge: Fragmented and Incomplete Benefit Data

Initial data provided to our benefits configuration team included only the Evidence of Coverage (EOC) and a high-level cost share matrix. We were tasked with translating this limited input into detailed benefit grids, defining all cost shares for both payable and non-payable services. Complicating matters further, additional source-of-truth documents existed across the organization but had not been consolidated or shared, creating both risk and inefficiencies.

Our Solution: Building a Repeatable Framework for Accuracy and Scale

We began by developing a centralized data model to integrate all available benefit sources into a single repository. This allowed us to audit data quality, uncover inconsistencies, and validate the accuracy of each source.

From there, we reverse-engineered the client’s internal benefit grid standard to create a smart template that could analyze and classify EOC and cost share data. By doing this, we not only identified discrepancies but also enabled the client to clean and standardize their source-of-truth documents, providing a more reliable foundation for benefit configuration.

With validated data in place, we developed a custom macro-driven tool capable of ingesting the cost share matrix and automatically generating full, production-ready benefit grids. This tool accounted for plan-level details such as maximums, limitations, vendor carve-outs, and other nuanced criteria, transforming a previously manual process into a scalable, repeatable solution.

Impact: Speed, Accuracy, and Long-Term Capability

The result was a dramatic increase in speed and quality. What once took hours or days was reduced to minutes, with the added benefit of near-zero manual intervention. More importantly, the approach proved resilient: as benefit requirements evolved, the client could simply update the input file, and the macro-driven system would seamlessly generate updated grids.

Long-Term Value

Beyond solving the immediate post-acquisition integration challenge, our consulting firm delivered a lasting capability. By embedding repeatable logic, automation, and quality control into the benefit configuration process, we empowered the client to handle future changes with confidence and precision.