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Insurance automation for claim error and correction processing

Overview:

A National Health Insurance Provider faced the challenge of handling claim errors and corrections in their Facets system. Striving to eliminate manual inefficiencies and enhance accuracy, the organization partnered with Accelirate to unleash the power of insurance automation, revolutionizing their claim processing landscape.

Challenges:

The manual process required an SME to review emailed insurance claims, create correction copies, and resubmit them. The complexity deepened with the need to differentiate between ITS and Local claims, consuming valuable resources and impeding workflow efficiency.

Solutions:

Accelirate orchestrated a tailored robotic process automation in insurance solution that holistically addressed the challenges associated with both ITS and Local claims, propelling the organization towards unprecedented efficiency.

Local Claims Process:

The automation prowess extended to the processing of Local claims, enhancing efficiency and reducing manual effort:

Email Information Extraction:

The bot deftly extracted pertinent information from the influx of emails containing Local claims requiring correction, eliminating the need for manual data entry.

Claim Location:

Leveraging the power to automate insurance, the bot skillfully navigated the internal record system, accurately locating the master list of insurance claims and identifying specific claims in need of correction based on the provided information.

ITS Claims Process:

The insurance automation solution for ITS claims seamlessly navigated the following steps:
  • Extract Email Information: The intelligent bot 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.
  • Human 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.

Error-Free Corrections:

The bot efficiently applied corrections to each claim, ensuring accuracy and policy adherence. It also attached essential notes and Explanation of Benefits (EOB) codes for prompt human claim agent review.

SME Notifications:

Upon completion of the correction process, the bot seamlessly notified the designated subject matter expert, ensuring smooth handover and facilitating further action if any errors were encountered.

Results:

The insurance automation-driven transformation delivered substantial benefits, elevating operational efficiency and streamlining claim processing.

ITS Claims

1,600+

Monthly Man Hour Savings

 

1 minute

Automated Claim Processing Time


Local Claims

1,300+

Monthly Man Hour Savings

 

2.5 minute

Automated Claim Processing Time