Context
A healthcare administrator faced mounting billing exceptions, delayed approvals, and inconsistent documentation.
What was broken
- Exception rules lived in inboxes and spreadsheets.
- Approvals stalled because decision thresholds were unclear.
- Compliance evidence was scattered across systems.
What was redesigned
- A rules-based exception catalog with clear ownership.
- A decision ladder aligned to compliance thresholds.
- A knowledge base of policy citations linked to each step.
Outcome
The team reduced rework, improved audit readiness, and gained a reliable path from claim intake to resolution.