RP Sanjiv Goenka Group


Claim Review & Appeal

Automating claims appeal process for improved productivity

Bot Profile



Robotic Process Automation



Cycle Time


Cost to Close


Reduced cycle time for appeal

Increased productivity

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    Problem Statement

    Operation teams review claim denials from payers, identifying the need and scope of appeal, and moving the claim to appeal queue which is accessed by a claim specialist to retrieve key information and update the payor claim review form. The form is fed back into the system to file the claim via EDI with the payor which increases cycle time for claim review submission and is inefficient.


    Our team eliminated the need for human intervention issues by deploying an automated solution  to fill in the claim review form and improved productivity and reduced cycle time for claim appeals.

    Tech Specs

    Claim Review & Appeal CoBot is an unattended digital employee that uses RPA to submit claim denial review forms and offsetting the need for human intervention.


    Claims that need an appeal to be filed are populated based on standard rules in the claim review form for denial submission

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