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HEALTHCARE

Automation Drives Accuracy and Productivity in Claims Processing


The Challenge

A major U.S. health insurance plan migrated its claims processing from one system to another and experienced a decline in productivity that resulted in a backlog of about 300,000 claims. The company asked Cognizant to evaluate its claims processing system and develop a solution to reduce its claims backlog.

 


Our Approach

To clear the backlog the simplest solution would have been to hire additional claims processors. Instead, Cognizant examined all the steps in the company’s claims processing system to identify the root cause of the problem. We found that manual pricing in the new claims processing system contributed to both poor productivity and pricing inaccuracies. After that, we designed a solution using robotic process automation (RPA) that includes automated pricing, along with a slew of other process improvements.

We tested the platform with claims submitted electronically by hospitals and ambulance services, and then later expanded the test to claims from a wider range of sources, including external websites, with accurate results.

Automated Claims Processing System Improves Productivity and Pricing Accuracy

Cognizant’s RPA solution significantly improved the company’s pricing accuracy, saving $1.7 million, and increased its productivity by 12 percent. By eliminating manual intervention, the most complex claims can now be priced in about 15 minutes, while a single-line entry can be priced in less than one minute.

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$1.7 million

savings to the client

12%

increase in productivity

92% to 98%

improvement in pricing accuracy


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