Case study: pharmacy services
Two growing workloads, one coordinated team to absorb them
Rising prescription volumes left a pharmacy services provider under pressure from two directions: a claims backlog that kept growing and a steady rise in partner inquiries. Internal teams were stretched across both, and response times were slipping.
Rather than rely only on internal hiring, the provider partnered with Ameridial to add a trained nearshore team that handled claims processing and pharmacy helpdesk support within one coordinated delivery structure.
Client
Pharmacy services provider
Services
Claims processing and pharmacy helpdesk
Delivery model
Nearshore, coordinated team
Outcome
Faster claims turnaround, steadier partner support
The challenge
As prescription activity grew, the same teams had to process more claims and answer more partner questions. The two workloads competed for the same people, and neither could wait.
A claims backlog that kept building
Incoming claims outpaced available processing capacity. Work accumulated, turnaround slowed, and delays spread downstream.
Partner inquiries rising at the same time
Partners needed timely, knowledgeable answers. Every hour spent on inquiries was an hour away from the claims queue.
More headcount alone would not solve it. The provider needed capacity that could flex with demand, understand pharmacy workflows, and meet its quality standards from the start.
The solution
Ameridial built a team from its nearshore delivery locations around the client’s existing operation. The aim was not to redesign how the provider worked, but to extend it with people trained to work inside its workflows and quality standards.
Claims processing support
Added capacity for the backlog, with agents trained in pharmacy terminology and claims adjudication. It applied the same discipline as Ameridial’s broader healthcare claims processing work.
Pharmacy helpdesk support
Dedicated capacity for partner inquiries, with agents trained on the client’s communication protocols, drawing on Ameridial’s pharmacy call center experience.
Running both under one structure meant the provider no longer had to pull people from claims to answer partners, or leave partners waiting while the backlog cleared.
How it worked
- 1Start from the client’s workflows. Its established processes and systems set the foundation.
- 2Train for the domain. The team learned the client’s systems, standards, and pharmacy processes.
- 3Take on live work. Agents began processing claims and answering partner inquiries.
- 4Hold to quality standards. Throughput never came at the cost of accuracy.
- 5Standardize delivery. Consistent processes reduced variation across both workstreams.
- 6Flex with demand. Capacity expanded in busy periods without a new hiring cycle.
Training covered six areas: client workflows, client systems, quality standards, pharmacy terminology, claims adjudication, and partner communication protocols.
The results
Faster claims turnaround
Claims moved through the workflow faster, and the backlog behind downstream delays was reduced.
Stronger partner support
More consistent first-contact resolution contributed to improved partner satisfaction.
Flexible capacity
Support expanded during high-volume periods without depending solely on internal hiring.
Greater consistency
Standardized processes led to fewer errors and improved compliance readiness.
The takeaway
Claims backlogs and partner inquiries were two sides of the same capacity problem. What made the difference was not more people, but prepared people: a team trained in pharmacy processes and working within one coordinated structure.
The same approach applies to pharmacy benefit managers, specialty pharmacies, and other organizations facing growing volume. Explore Ameridial’s full range of pharmacy BPO services.
Is volume outpacing your pharmacy team?
Tell us where the pressure is. We’ll show you where added claims or helpdesk capacity would help most.
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