RPA for Healthcare payer

The automatic solution for happier customers

up to 36%
of healthcare is plausible for automation
up to 60%
of work done by healthcare specialist
can be automated
up to 95%
of claims handling tasks for healthcare payers can be done faster with RPA

Better outcome for claims processing

Similar to insurers, health plans need to reduce costs, improve quality and make customer happier, while following regulations. This is why health insurers look over claims processing operations closely for chances of saving money. As a matter of fact, the insurer pays about $3 per claim for 70% of successful claims process. Failed claims which require manual processing to review exceptions or invalid information takes about $28 per claim from the insurer. This means the cost is almost 10 times as much. Thanks to auto-adjudication, inexpensive claims are now available

for healthcare plans. Nonetheless, a lot of claims are still not covered by business rules which are defined by the old technology stacks. This is very common in many claims processing business. Our software helps healthcare customers to see it as claim fixing bots which are integrated with backend systems seamlessly. In addition, we bring smart automation to failed claims which are used to be very expensive. Our solutions minimize claim processing cycle and reduce costs dramatically. Customers can make changes to workflow rapidly with out affecting current performance.

Healthcare payer obstacles and solutions

Automation for errors

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.