CoBot

Claims Edit Automation

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

Bot Profile

Efficiency

Complexity

Robotic Process Automation

Technology

Outcomes

AHT

Straight Through Processing

Cost to Close

Benefits

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.

    Solution

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

    Tech Specs

    .Net based custom development

    Expertise

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