Challenge
A leading health plan with millions of members faced significant operational inefficiencies due to manual processes across multiple departments. These inefficiencies were time-consuming, hindered service quality, and negatively impacted the organization’s bottom line. Key areas such as Claims, Care Management, Enrollment & Billing, and Pharmacy Benefit Management were experiencing bottlenecks, leading to delays, higher operational costs, and reduced productivity. The health plan recognized the need to streamline operations through automation to boost productivity and improve cost-effectiveness.
Solution
The health plan partnered with Emids to deploy an enterprise-wide intelligent automation solution. Leveraging UiPath’s automation platform, Emids implemented a comprehensive suite of automated processes across multiple business functions. The solution included:
- Automation Center of Excellence (COE) Setup: Emids established an Automation Center of Excellence (COE) to identify high-impact automation use cases and ensure alignment with the health plan’s business objectives. This COE developed a long-term automation roadmap, ensuring the successful deployment of automation across the organization.
- Intelligent Process Automation Strategy and Roadmap: A comprehensive automation strategy was created to prioritize and streamline processes across departments. This roadmap served as a guide for automating various business functions and driving continuous improvements.
- Automation of Key Business Processes: Emids automated critical processes in areas such as:
- Claims Processing
- Care Management
- Enrolment & Billing
- Pharmacy Benefit Management
- Customer Service and Appeals
These automations significantly reduced manual efforts and increased operational efficiency across the board.
- Savings Dashboard: A customized savings dashboard was implemented to provide real-time tracking of the financial and operational impacts of automation. This allowed the leadership to monitor performance and adjust strategies based on data-driven insights.
Outcomes
The implementation of intelligent automation delivered significant results for the health plan, leading to improved productivity, cost savings, and operational efficiency. Key outcomes included:
- 650,000+ hours saved across the organization through process automation.
- 370+ processes automated across claims, billing, and enrolment.
- Cumulative savings of over $12M within the first three years, delivering a 400% ROI.
- 14,000 COVID-related claims adjustments processed within three weeks, showcasing the agility and responsiveness of the automation system.
- 40% reduction in processing time for primary care provider (PCP) change requests.
- More than 30% reduction in clinicians’ administrative tasks, allowing for more time to focus on patient care.
- $600K savings from the automation of the claims process alone.
- Real-time reporting of bot performance, providing operational insights and enabling continuous refinement of the automation strategy.
By integrating intelligent automation into their core processes, the client achieved significant operational efficiencies, cost savings, and service improvements. The success of this initiative positioned them to leverage automation as a key component of its long-term strategy, ensuring a competitive edge in the healthcare industry.
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