Claims Automation Saving Payer ~$6 Million

SCENARIO

About the Client

A top five payer was looking for an end-to-end automated solutions to reduce their cost of operations. Sagility identified an opportunity with the corrected claims business, where 50% of the overall volumes can be completed by a bot (with no manual intervention) with 99.99% accuracy.

Claims Troubleshooting

The scope of RPA, leveraging over 20+ bots with potential to increase to 50, addressed both medical and hospital claims, which involves corrections compared to the original claims. The scope of the solutions includes bot validating the allowable for the services/claims by accessing a few legacy applications and determining the action further basis the original payment made.

SOLUTION

Sagility collaborated with the client’s team and developed RPA solutions for end-to-end claims processing for corrected claims business. The team was able to develop the solutions to complete almost 35% – 40% of the volumes within 6-7 months timeline with 99.99% accuracy.

End-to-end Process Improvements:

The in-scope claims for this solution were excluded from the manual intervention and are handled by bots completely. The bot will compare the original and corrected claim, identify the changes if any and incorporate those and complete the process end to end.

RESULTS

End-to-end automation on corrected claims processing with 40% completion rate at 99.99% accuracy
Increased accuracy for the claims handled by bots
Potential of $6 million in savings across the enterprise
3.5 million claims to be processed annually

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