INDUSTRY: Insurance
How Accelirate’s Automated Claims Processing
Saves 2,900+ Hours Monthly for National Health Insurance Provider
1,600+
Hrs Saved Monthly
(ITS Claims)
1,300+
Hrs Saved Monthly
(Local Claims)
1 Min
Automated Processing
Time (ITS Claims)
2.5 Mins
Automated Processing
Time (Local Claims)
Client Overview
The client is a national health insurance provider that offers a wide range of products and services to individuals and businesses. Their core business revolves around providing comprehensive health insurance coverage, ensuring policyholders have access to quality medical care and seamless claim processing.
Key Takeaways
- Enhanced efficiency and accuracy in claim processing with advanced RPA.
- Significant reduction in manual effort, claim errors and processing time.
- Streamlined workflow, notifications and improved policy adherence.
The client, a prominent national health insurance provider, faced challenges in handling claim errors and corrections within their Facets system. The manual process required significant time and resources, impacting workflow efficiency and accuracy. To address these inefficiencies, they partnered with Accelirate, a global automation provider, to leverage the benefits of insurance automation.
Accelirate worked closely with the client to redefine their insurance services through innovative digital integration. The client sought to expand their offerings by embracing a more efficient claim processing system, seamlessly integrating various digital tools to provide secure and efficient insurance experiences to a broader customer base.
Tackling Manual Inefficiencies with Advanced Claims Processing Automation
The client faced several challenges in its claim error and correction processing that affected efficiency and accuracy. The manual process was time-consuming and prone to errors, requiring SMEs to review emailed claims, create correction copies, and resubmit them. Differentiating between Local claims and ITS added to the complexity, consuming valuable resources.
Accelirate devised a comprehensive solution wherein a tailored insurance claims automation was implemented that holistically addressed the challenges associated with both Local claims and ITS.
01 - Local Claims Process
- Email Information Extraction: The bot extracted pertinent information from emails containing Local claims, eliminating manual data entry.
- Claim Location: The bot navigated the internal record system, locating insurance claims needing correction based on the provided information.
- Error-Free Corrections: The bot applied corrections to each claim, ensuring accuracy and attaching essential notes and Explanation of Benefits (EOB) codes for review.
- SME Notifications: The bot notified the designated SME upon completing corrections, facilitating further action if any errors were encountered.
02 - ITS Claims Process
The automated claims processing solution for ITS seamlessly navigated the following steps:
- Extract Email Information: The intelligent automation effortlessly captured the required details from the influx of emailed insurance claim lists, avoiding any manual intervention.
- Match and Copy Claims: Leveraging the power of insurance automation, the bot efficiently matched the claim information to the internal Facets system, creating precise copies of the original claims that required correction. These copies maintained the integrity of the original document and allowed for swift and accurate modifications.
- Streamlined Updates: With precision and speed, the bot diligently executed the necessary corrections within the copied claims, ensuring seamless processing. Any errors that couldn’t be rectified were efficiently flagged and escalated for the attention of a human SME.
- SME Intervention: In cases where manual expertise was required, the bot seamlessly redirected the flagged claims to a human subject matter expert, facilitating prompt resolution and maintaining process continuity.
Enhancing Efficiency and Precision with Transformative Benefits of Insurance Automation
The implementation of RPA for claims processing at the national health insurance provider has delivered significant benefits, transforming the way the organization manages its claims. By leveraging advanced robotic process automation solutions, the organization has not only streamlined its operations but also significantly enhanced accuracy and efficiency. This unique solution addressed both ITS and Local claims, allowing for comprehensive automation that catered to the specific needs of each claim type. As a result, the insurance provider has seen remarkable improvements in processing times and overall productivity. Don’t believe us? See for yourself!
01 - Local Claims:
- 1,300+ Monthly Work Hour Savings: Automation of Local claims also led to substantial time savings, enhancing the overall productivity of the claims department.
- 2.5 Minute Automated Claims Processing Time: The automated process streamlined the handling of Local claims, reducing the processing time to just 2.5 minutes per claim.
02 - ITS Claims:
- 1,600+ Monthly Work Hour Savings: Automation freed up significant time that was previously spent on manual claims processing, allowing SMEs to focus on more strategic tasks.
- 1 Minute Automated Claims Processing Time: The intelligent bot reduced the time required to process each claim to just one minute, vastly improving operational efficiency.
03 - Enhanced Accuracy:
The precision of the RPA bot in extracting and processing claim information minimized errors, ensuring that corrections were applied accurately the first time. This led to greater compliance with policies and reduced the need for further corrections.
04 - Improved SME Productivity:
By automating the routine aspects of claims processing, SMEs were able to dedicate more time to complex cases and strategic initiatives, enhancing the value they brought to the organization.
05 - Scalability and Flexibility:
The tailored RPA solution was designed to handle a variety of claim types and scenarios, making it a robust and scalable solution that could grow with the organization’s needs.
06 - Scalability and Robustness:
06 – Customer Satisfaction:
Simplify Claims Processing with Smart Automation Solutions
This insurance claims automation case study reiterates the impact of intelligent automation in the insurance sector. Through our partnership with the leading health insurance provider, we have witnessed the transformative power of automation in achieving better ROI, operational efficiency, and customer satisfaction while ensuring accuracy in claims processing.
The client faced challenges in managing claim errors and corrections manually. However, by implementing tailored RPA solutions, they experienced a significant shift. Not only did their process become more streamlined, but they also saved a lot of time in the claim process automation, enabling their team to focus on more strategic tasks. So, if you are also looking to revolutionize your claim processing operations, associate with a trusted AI and Automation partner, like Accelirate and achieve similar results. Connect with us today!
