RP Sanjiv Goenka Group


Claims Edit Automation

Using RPA to manage business exceptions (EDITs) in claims adjudication & approval

Bot Profile



Robotic Process Automation




Straight Through Processing

Cost to Close


Efficiency Improvement, faster to process a claim

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    Problem Statement

    On average, processing every healthcare claim involves 100s of Edits with multiple validations. With the operations team having to manually check standard operating procedures (SOPs) for millions of claims each year across these Edits, the throughput of claims processing is sub-optimal. In addition, every Edit has to be resolved by navigating through more than 10 screens which is extremely time consuming.


    The solution team implemented Intelligent Automation to manage more than 750,000 Edits annually without human intervention.

    Tech Specs

    .Net based custom development


    • Advanced claims management with decreased manual intervention
    • Lowering overall turnaround time to process claims

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