of healthcare is plausible for automation
of work done by healthcare specialist
can be automated
of claims handling tasks for healthcare payers can be done faster with RPA
Healthcare payer obstacles and solutions
Automation for errors
A insurer found that five to six hundred claims were being dropped every day because of an error code for missing or invalid data. The employees need to work on these claims manually to edit or update the claim information from other systems. These claims were only about four to five percent of the total, however they affect the claim group a lot because this is a constant bottle neck.
The RPA solution was bots with scripts built with rules of the claims group to fix the issues. The manual solution and the automated one were both not superb - the claim still waited for solution. However, our bots reduced 15 FTEs from this manual process which saved customer a compelling cost, and waiting time of three or four business day were replaced by a resolution within 24 hours.
Automation for modification
There are many claims needed to be modified, such as noncompliant ID card number, gender, expire date ... A number from six to twelve thousand claims are needed to be processed manually. This process includes many steps to find and update information.
Thanks to RPA, the claims updated by bots which are programmed to make required changes. The bots execute all the steps in claims system, scan the data, update information and submit the modified claim into the claims systems again.
Automation for complicated claims
A more efficient way for processing benefit claims is required. The rules for these claims are very complex. Normally, the insured are based on their health plans and also plans from their spouses. Therefore, the benefits between these plans must be well understood. It also needs to be assured that the total claim is not exceeded. This seems to be not a job for machine.
Our RPA software arrange those claims for bots to prepare all the required documents. After that, it sends every documents to claims agents. Lifting this kind of work from the agents' shoulder helps them to focus on making better decisions which requires human.