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Optimized Non-Standard Claims Processing For A Fortune 500 Insurance Giant

Client

A highly diversified Fortune 500 company into healthcare and insurance business and access to care through networks that include 1.2 million physicians and other health care professionals and approximately 6,500 hospitals and other facilities.


Industry 

Healthcare


Region

United States of America

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Challenges

The client was struggling with the processing of the non-standard claims of its customers as the documents had uncertain field locations and multiple sub-documents.

The entire process of searching the field locations and entering the customer data was done manually, which affected the overall productivity of the employees.

The processed documents had multiple errors which led to a significant reduction in the accuracy level of the claim documents.

Solution

Datamatics experts reviewed the claim documents and prioritized the stamp codes and set the page priority to zone the fields as per specifications.

They collated various unstructured sample documents and trained the FTEs on the critical fields while processing them.

Datamatics updated the business validation for the QC application and added new features at the documents comparing stage for smooth and efficient processing of the claims.

Impact

cc63

97%

Overall Internal accuracy achieved

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50 Claims

Processed by per FTE per day

cc350

Reduction

In overall processing cycle time

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25%

Increase in overall productivity