Services
A Healthcare Benefits Administrator Achieved Claims Workflow Transformation with AI-based Interventions
BUSINESS CHALLENGE
A leading healthcare benefits administrator.
The client has 375+ corporate clients and processed approx. 18M claims annually. Long adjudication timelines, multiple iterations on complex cases, a highly manual process and poor pre-processing of claim data led to high operating costs and fraudulent claims, affecting regulatory compliance.
Mphasis transformed the client’s claims adjudication workflow through five interventions:
Reduced submission timeline from 30min-1day to 10 min
Reduced classification and processing time from 2 days to 2 hours
Validation & adjudication time reduced from 2 days to 2 hours
Average turnaround reduced from 3-5 days to 5 hours