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Case study

The challenge

PacificSource is a not-for-profit health payer operating in the Pacific Northwest of the United States that serves members through highly regulated lines of business. Due to a manual process for claims transactions that was slow and resource-intensive, the payer found it difficult to keep up with increasingly fluid changes among members, plans and providers. To pinpoint where issues were arising, PacificSource documented the time and labor expenses for four transactions—adjustments, Medicaid below-the-line (BTL) claims, duplicate claims and Coordination of Benefits (COB). The estimated cost for 29 full-time employees to process these four transaction types was nearly $1.8 million per year. PacificSource required a solution that could adapt quickly to frequent regulatory updates and contain processing costs, while enabling the company to deliver high-quality experiences to members, providers and state regulators.

Our approach

As an existing client of Cognizant, PacificSource chose Cognizant® Robotic Automation Services because of our experience as a fully managed robotic process automation (RPA) solution and our ability to facilitate cost savings, build a team to manage the new solution and provide it all in line with the payer’s budget. PacificSource’s process owners and subject matter experts worked together with our automation specialists to develop bots that could address the key operational pain points. 

The capabilities of the robots address the challenges around speed and accuracy of reimbursing providers and responding to member care, including the ability to process work in a fraction of the time humans require, achieve accurate results and eliminate manual intervention. They also offer stopgap automation such as connecting two systems until an IT change can be implemented.

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Robotic automation reclaims time and resources

PacificSource has greatly improved the accuracy of its key transactions, reducing the risk of delays and regulatory penalties. These changes have improved member and provider relations by speeding additional related transactions, including claims adjudication and reimbursements. Time per adjustment has dropped to approximately two minutes from 10 and the annual labor cost savings is $691,200. Bots now process a claim verification in four minutes or less as compared to 10 minutes per employee. PacificSource now uses a bot to go from a daily backlog to a daily fully automated clearing, saving 52% in labor cost. The COB bot continues to help PacificSource avoid spending five minutes per transaction—with 2,700 monthly transactions, the bot has returned nearly 3,000 hours to the business since deployment.


work hours returned to PacificSource since deployment


reduced annual labor costs for claims adjustments


saved in annual labor costs across all automated processes