Introduction
A leading multistate government health plan needed to reduce operating costs by more than 20%. Traditional cost-saving levers such as offshore delivery and robotic process automation had reached their limits. The client partnered with Firstsource to deploy AI-powered Claims as a Service, targeting quick wins and guaranteed multimillion-dollar savings.
Challenge
Accelerate delivery of aggressive cost savings with AI
Firstsource had a long-time relationship with the client, a national leader in government health plans delivering services across the health plan value chain. This heavily regulated line of business had constrained our client from popular cost savings measures, such as using offshore resources. It had invested in a variety of robotic process automation solutions but was finding these had reached the limits of their utility. In exploring ways to reduce costs and increase efficiency, our Firstsource team had been evaluating potential uses for AI within our client’s claims operations.
The client’s executive management team and board set an aggressive savings goal, which was to reduce operating costs by more than 20%. That became the catalyst for implementing the AI solutions we had proposed for claims operations. Our client did not want to wait the typical 18 to 24 months to see a return on the organization’s AI investments, however. The company needed quick wins and near-term savings.
How We Made It Happen
Claims as a Service solution
- we asked the client to delegate its entire claims operation process to us to ensure that we have full control over optimizing all upstream and downstream functions
- We assumed end-to-end accountability for our client’s claims operations performance, includingany state or federal penalties resulting from inaccuracies or missed deadlines.
- We worked through a commercial structure to deliver up front savings to the client, spreading $25M across four years.
Eliminate, accelerate and debottleneck
- Deployed prebuilt AI claims decision agents to eliminate a variety of manual processes, delivering an estimated 25-30% cost savings.
- These modular, self learning agents can easily expand and connect agents to drive automation deeper into the claims cycle and potentially the revenue cycle.
Introduced AI co-pilots for smarter work
- Introduced AI co-pilots like Sara and SONAR that anticipate and deliver the information claims examiners need to review a complex claim quickly and accurately.
- Improved examiner productivity by 15%+ through faster, more accurate claim reviews.
Optimizing multistate operations
- Optimized operations across our client’s government health plans in different states, reducing waste and overhead by standardizing processes.
- Leveraged process mining solutions to pinpoint inefficiencies and bottlenecks and reveal precisely how to address them.
- Executed a seamless rebadging of client personnel to deliver immediate savings while ensuring knowledge retention and process continuity.
Conclusion
Firstsource’s AI-driven Claims as a Service solution delivered immediate impact, cutting costs by up to 30% and guaranteeing $25M in savings over four years. With AI agents and co-pilots now embedded in operations, now the client can process claims faster, more accurately, and at scale. Strong executive sponsorship and a flexible AI framework ensure sustainable efficiencies and a futureproof foundation for growth.