Case Study
RPA Claims Processing: Automating 5,000 Claim Audits Per Week

>>RPA Claims Processing: Automating 5,000 Claim Audits Per Week
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Abstract

A major healthcare product and service organization was hindered by an onerous, manual claims audit process. SDLC Partners was able to utilize RPA to streamline their claims processing times, while freeing up auditors to work on other, critical business growth priorities.

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The Challenge

The client’s claims auditing team had to manually process ~5,000 claims per week with limited resources, which took them ~30-35 minutes to process each claim.

Their claims auditors had to access multiple web and mainframe applications to determine the final claim pricing. This became a tedious and time-consuming process prone to human error. Additionally, before RPA, the claims process was dependent on application and auditor availability, which hindered the possibility of speeding up their manual process.

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The Solution

We collaborated with this healthcare client to analyze their claims auditing process, end-to-end, conducting several interview sessions to elicit their technical and business requirements.

Our team implemented Six Sigma techniques to remove defects and optimize their process. With a greatly improved process at the ready, the team designed an RPA solution using Blue Prism. The RPA bots were programmed to perform the entire audit process and generate the required artifacts as proof of the audit chain of activities.

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The Results

Our RPA claims processing solution could now handle more claims in a given time with consistent results, automating the documentation for each claim as well. Not only was the accuracy rate significantly higher, as compared to the manual process, but the streamlined process also led to higher customer satisfaction scores.

We removed redundancies and consolidated their process, optimizing speed-to-audit resolution.

Successful automation freed auditors to work on other areas, solving meaningful business growth issues. As a result, 50 percent of their auditors were promoted to senior roles.

We were able to automate their audit process, as well as generate new reports and dashboards, providing execution and audit results. This new intelligence helped executives understand their KPIs and make more data-driven decisions.

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“With ever-growing customer demands and market competition, it has become paramount that we improve our delivery lifecycle and SDLC has ensured that
we have done that.”

Casi Johnson, Chief Operations Officer/Innovations Leader, M3 Accounting + Analytics