Case study

The challenge

A major U.S. health insurer, operating more than 30 health plans for 30 million members, wanted to streamline its ancillary claims administrative functions through automation. The company wanted to implement an enterprise-wide automation strategy that will digitally transform its numerous business functions, including how the insurer processes approximately 100,000 health insurance claims per day. The company also wanted to improve the member experience through quick and accurate claims settlement.

Our approach

The insurer engaged Cognizant, its long-time IT and business operations partner, to provide automation solutions. We developed and implemented cloud-based intelligent process automation, effectively augmenting the client’s workforce with more than 2,000 bots. These bots run 20 hours a day, six days a week, and have self-healing properties to ensure minimum downtime without manual intervention. Liaising with the insurer, we supported the creation of an automation center of excellence for collaboration across business units. The continuous integration and continuous deployment process boosted the client’s claims processing capacity to 3.5 million per month. Besides claims adjudication, our robotic process automation solutions enable payment integrity, benefits coordination and claims reclassification.

Our bots make the client more flexible in tackling emerging business needs, like addressing the operational impacts of COVID-19. In four weeks, we configured bots to help the Centers for Medicare and Medicaid Services reverse its claims sequestration policy and ensure providers receive accurate reimbursements. Cognizant’s bot analytics dashboard also enables transparent reporting and supports bot performance fine-tuning. In addition, Cognizant developed an opioid lock-in process that automates the end-to-end analysis, detection and prevention of opioid/narcotics (controlled) drug abuse.

Automation enhances member experiences, improves efficiencies, lowers costs

By deploying bots, Cognizant helps the insurer not only enhance member experiences and conform to regulatory compliance processes but also lower costs. This has helped the insurer save $40 million each year by processing 43+ million claims per year. Now, claims are processed 600% faster with a 99% success rate and 8X ROI. The new automation center of excellence provides a foundation from which the client can expand automation to more sophisticated business transactions and respond effectively to dynamic market needs.

$40M

saved per year by processing 43+ million claims per year

8X

ROI through cloud-based automation

600%

faster claims processing