$14 Billion Healthcare Insurance Company
Compliance Department Creation and Implementation
A large health insurance company needed to bring business processes into compliance with the Affordable Care Act (ACA). They decided to enlist the help of consultants with strong governance, risk and compliance expertise and engaged RGP.
How We Helped
After conducting an assessment to understand the organization’s processes, our Project Manager and Team customized proprietary RGP tools, templates and processes to reflect the client’s environment, culture and strategies. Then we helped establish and operationalize an oversight function to address commercial health insurance processes, compliance with the ACA, ERISA, individual Department of Insurance requirements and other critical needs.
With the support of our Client, we conducted key stakeholder interviews to develop and deliver:
- Oversight process maps and oversight triggers
- Risk and control models and risk rating
- Test design, walkthroughs, testing, and monitoring visuals and narratives
- A policy and procedures toolkit
- Interview tips and techniques
- Training materials
- Designated downstream entities' risk management lifecycle and group compliance oversight
We completed the project early and under budget. In addition to the deliverables in the Scope of Work, we conducted a process mapping exercise, which was valuable to the organization.
RGP’s contributions resulted in a "ready for business" internal Compliance Team with an array of tools, templates and methodologies to carry out their charter (oversight of the group health insurance business and compliance with the Affordable Care Act and other related regulations). Our Client remarked repeatedly that RGP "…far exceeded our expectations in both how the project was conducted and in the final deliverables given."