Healthcare Appeals | WorkFusion

Improving the Healthcare Appeals Experience through RPA

Customer: Major U.S. health care coverage administrator
Problem

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.

Solution

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.

Benefit

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.

Impact
85%
Reduced manual work
99%
Accuracy
3m
Time cut from 15 minutes
How did we do it?
Find out more about the AI-driven RPA capabilities in WorkFusion’s Smart Process Automation and how we automate work that’s too complex for rules by turning high-volume data into smarter automation.
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