Improving the Healthcare Appeals Experience through RPA
When members submit a policy complaint or want to appeal a decision, one of several teams must review the case. Appeals are requested via email, fax, phone or through a web form. Information, including member name and complaint type, must be manually entered to start the appeal process. That’s time- and labor-intensive, and prone to errors — and any slowdown of an appeal can cost significant time and money.
The operations team at the company used WorkFusion Smart Process Automation to transform a completely manual process into an automated workflow. First, SPA extracts data from emails using robotics and OCR, and then uses machine learning models to classify and route requests into queues. Efficiency plus accuracy is achieved via an exception-handling workflow that includes a human-in-the-loop step for anything the bots are initially unable to process, such as handwriting.
Using SPA to automate 85 percent of the full workflow improves the customer experience because automating classification saves time and money, prevents misdirection and reduces human error. Intelligent Automation also improves routing accuracy, sending the right data to the right queue, the first time.