Operational Efficiency: File & Workflow Modernization
Background
When I joined Affinity Health Plan as the Manager of Claims Operations, the entire Claims Reconsideration operation was running on 100% paper-based workflows.
Every single document — corrected claims, appeals, grievances, COB, DHS regulatory items, member reimbursements, Payment Integrity checks, provider disputes — came in as physical paper stored in drawers, file cabinets, and boxes.
This created massive operational breakdowns:
73,000+ backlog
100+ day aging
High error & compliance exposure
No visibility into daily throughput
No digital workflow, intake, or tracking system
Inconsistent processes across Claims, Appeals & Grievances, Payment Integrity & Recovery, Regulatory Department (DHS), and Mailroom
Provider satisfaction issues and regulatory delays
Leadership assigned me to modernize, digitize, and stabilize the entire ecosystem; complete lifecycle.
My Role
I served as the:
Operational lead
Workflow & system architect
Implementation owner
Cross-department liaison
Training & reporting lead
Accountability & governance driver
I oversaw operations for Claims Resolutions, Adjustments Allocation, Member Reimbursements, and DHS cases, and collaborated closely with A&G, Payment Integrity, the Mailroom vendor partners to fulfill requests and complete required adjustments.
Key Challenges
100% paper workflows
No scanning or digital intake
No digital folders, routing, or tracking
Vendor mailroom with zero structure in routing to the appropriate departments
Thousands of documents weekly
No aging visibility
No real-time reporting
Constant compliance risk
High misrouting & manual errors
No workflow accountability
Actions & Solutions Delivered
Designed the full digital workflow architecture
Transformed ALL paper workflows into a centralized digital system
Built electronic pipelines for:
Corrected claims (IP/OP/HCFA)
Appeals & Grievances
COB
Member reimbursements
DHS reconsiderations
Coding & clinical appeals
Payment Integrity check workflows
Established daily scanning & digital intake (vendor partnership)
Implemented daily scanning of all incoming mail
Built digital intake buckets for every category
Eliminated physical drawers permanently
Built a centralized categorical sorting system
Created digital structures for all claim and reconsideration types, enabling accuracy and speed.
Built & trained a specialized staff in digital allocation
Staff trained to properly classify EVERY scanned item
Eliminated misrouting and reduced handling errors
Optimized processing times
Developed a digital aging & inventory reporting system
Created real-time aging visibility
Built Excel + Tableau dashboards
Implemented analytics for weekly ELT reporting
Introduced throughput, inflow/outflow, and staffing efficiency metrics
Automated prioritization model
Created digital “priority folders” based on:
Aging
Regulatory timelines
Claim type
Staffing load
Compliance risk
Enabled Claims to process work strategically and efficiently.
Full cross-department alignment & governance
Partnered across A&G, PI, DHS, Mailroom vendor, and Claims leadership to streamline workflows, eliminate duplicate work, and align regulatory processes.
Results & Impact (Within Six Months)
Massive Operational Turnaround
Reduced backlog from 73,000+ to current (under 15 days)
Cut aging from 100+ days → under 15 days
Improved turnaround times by 80%
Eliminated compliance risk tied to DHS and appeals
Reduced misrouting and errors across all departments
Enabled ELT-ready reporting with daily visibility
Created sustainable, repeatable workflows still used enterprise-wide
Cost Reduction & Staffing Efficiency
The new metric added cleanly:
Reduced labor utilization by 35% monthly due to new digital workflow
Saved $75,000 in labor costs in Q1 alone
Reduced overtime and unnecessary manual touchpoints
Reallocated staff to higher-value tasks instead of paper sorting
Recognition
Received formal written recognition from Affinity leadership (CEO Michael Murphy, 2019) for the dramatic Claims inventory reduction and operational performance improvements.