New Member Enrollment Accuracy Rate

New Member Enrollment Accuracy Rate

KPI Details

New Member Enrollment Accuracy Rate measures the number of accurate new member health plan enrollments completed (i.e., enrollments that do not have errors, or missing information/documentation) in relation to the total number of enrollments completed over the same period of time. A relatively low value for this metric is typically related to a few common factors, including highly manual enrollment processes (i.e., manual application submissions, data entries, etc.), inefficient call script and customer communication policies, poor customer contact tracking and management (i.e., tracking of customer communications and contact information), and sub-par health insurance back office employee training and performance. Each of these factors can lead to increased error rates, longer cycle times and increased customer confusion and dissatisfaction which can vastly increase operating expenses and customer attrition rates.

KPI Definition

The number of accurate new member health plan enrollments completed (i.e., enrollments that do not have errors, or missing information/documentation) divided by the total number of enrollments completed over the same period of time, as a percentage.

KPI Best Practices

• Create standard insurance applications with validated data inputs to reduce manual errors
• Verify that applications are complete before passing on to underwriting
• Document instances of inaccurate enrollment to identify trends and root causes over time

KPI Calculation Instructions New Member Enrollment Accuracy Rate?

Two numbers are used to calculate this KPI: (1) the number of accurate new member health plan enrollments completed, and (2) the total number of enrollments completed over the same period of time. Accurate new member health plan enrollments are considered to be health plan enrollments that do not contain errors, or missing information/ documentation (i.e., customer contact information, etc.) once the enrollment is completed. Completed enrollments are considered to be enrollment applications that results in a customer being approved to receive a policy from a health insurance company.

KPI Formula :

(Accurate New Member Enrollments / Total Enrollments Processed) * 100