AI and Automation Revolutionize Claims Management for Fortune 500 Insurer

Challenges

This Fortune 500 insurer faced a multitude of claims processing challenges:

• High Manual Workload: Daily claims across various channels, with 35% of contact center calls related to claims, resulted in a high volume of manual processing.
• Paper-Based Claims: A significant number of paper claims further slowed down processing times.
• Error-Prone Adjudication: Manual processing led to a high rate of errors, including missed benefits, underpayments, and overpayments, resulting in fines and penalties.
• Fraudulent Transactions: The manual system left room for fraudulent transactions.

These challenges combined to increase costs, slow down claims processing, and damage customer satisfaction.

Solution

Coforge implemented a comprehensive AI and automation solution to streamline claims processing:

• Orchestrated AI & RPA: A combined approach using AI for intelligent document processing and RPA for task automation transformed claims intake and management.
• Intelligent Automation Tools: Coforge's Document AI proprietary solution handled structured, semi-structured, and unstructured documents. An ML-based solution (Coforge ML-based IVIS) facilitated claim triage and adjudication. Smart RPA bots automated tasks.
• Advanced Analytics & Process Optimization: Knowledge graph analytics provided insights into customer behavior and fraud forensics. Process discovery and mining through Coforge ProcessGym™ led to sustainable demand generation.

The Impact

End state savings of more than 75%, that includes process, design, automation, right shoring and business model change. This translates to significant improvements across various aspects of claims processing: