Health Insurance KPIs, Metrics & Benchmarks

KPIs & Metrics to Measure and Manage Health Plan Performance

What are Health Insurance KPIs?

The focus of health insurance metrics and Key Performance Indicators (KPIs) is measuring the effectiveness and efficiency of a health insurance company’s ability to deliver health plan benefits to its customers. Often this includes different processes, such as member on-boarding, member services, new business processing, provider network management and claims processing.

Using Health Insurance Metrics to Manage Department Performance

Health insurance operations include three major aspects: provider network development and management, claims processing and member services. Effective service for both plan members and healthcare providers (doctors, clinics, pharmacies, etc.) is vital to the growth of any health plan. KPIs for health insurance companies measure the effectiveness of the company’s provider network, the level of service provided to its members and operational efficiency in areas such as claims and member services.

The Top 5 Metrics for Health Insurance Companies

Health insurance companies in the United States are required to invest a certain percentage of premiums earned back into the business to improve operations and quality of care. KPIs and metrics can help to identify areas where the health plan can improve operations and customer experience. Here are 5 common health plan KPIs:

  1. 1.Medical Loss Ratio (MLR)
  2. 2.Claim Settlement Cycle Time (Medical)
  3. 3.Claims Denial Rate
  4. 4.Provider Contracting Cycle Time
  5. 5.First Contact Resolution Rate (Member Services)

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