46% Cost Savings with RPA for a Top European Healthcare Service Provider
CASESTUDY
AI, ML, Virtual Assistants and Automation Deliver Operational Excellence and 99% SLA much to the customer’s delight
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H&I
Our Customer
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AT A GLANCE
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Our client, a top health insurance broker and a risk consultant, wanted a rigid claims process. They have 500+ employees in customer service and back-office operations spread across Europe.
www.hexaware.com |
marketing@hexaware.com
Business Challenges
During hospitalization, our client was required to pay the complete hospital bill of the insured as per the invoice. The insured patient would then pay our client back by filling a declaration form for any exemptions or costs not covered within the guarantee.
Deliver self-service for 70% of the service requests and reduce dependency on the customer service center
Paperless delivery to reduce annual mailing volume by 50,000 – 70,000 pieces
Deliver digital experience for a positive impact on the policyholder’s satisfaction
Setting up accurate tooling for all aspects of testing to market
Reduce time/effort spent on new feature development
The client’s claim process had challenges like highly manual processes, high average call handling time, and mundane tasks. Hexaware stepped in to implement Robotics Process Automation (RPA) and achieve the below scope:
Automate hospitalization claims, day clinic claims, serial hospitalization claims, medical claims, and online declaration of admission
Build a scalable operating model to seamlessly include additional processes in the future
Our Solutions
Our Solution
Being the digital transformation partner of the leading pharmaceutical CSO, Hexaware analyzed their business challenges and realized that they need to change their business and customer delivery model, focusing on remote HCP engagement services.
OUR SOLUTIONS
The new-improved RPA-led claim process
Our RPA-enabled bots helped improve customer service to ensure claims were processed faster. We provided an automation solution for invoices in XML and the client’s AssurPharma based formats.
Client receives patient invoices (format - XML/email/web form/post/call, paper)
Bot investigates the declaration against the invoice
Verifies for details of person, hospital, date, address, serial hospitalization/ day clinic, etc.
Decides payback amount based on the insurance coverage and the standard operating procedures
Checks for legal intervention and calculates the amount to be paid by the mutuality
Bot finalizes the declaration package and generates settlement notes
Additionally, Hexaware offered daily reporting of tasks such as
• Total claims received • Claims successfully processed • Claims failed due to business exceptions
• Claims failed due to technical exceptions • Claims backlog
Solution Highlights
• End-to-end processes specified above using RPA while managing the business-critical SLAs • RPA platform to drive automation and realize automation benefits in a short timeframe • Operational performance delivered in an improved manner led to progressive standardization and improvement in the operating model
End-to-end processes specified above using RPA while managing the business-critical SLAs
RPA platform to drive automation and realize automation benefits in a short timeframe
Operational performance delivered in an improved manner led to progressive standardization and improvement in the operating model
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Business Benefits
HIGHLIGHTS
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Our holistic solution for deviation and amendments management led to excellence in clinical trials operations, effort reduction, and performance improvement.
85% of interactions previously through calls are now routed through chat
30% faster onboarding with automation and other enhancements like quick routing
Increase in customer satisfaction through focussed data to insights
Reduction in number of licenses. 30% faster onboarding with automation and other enhancements like quick routing 85% of interactions previously through calls are now routed through chat
Total cost-benefit of 46%
Steady-state savings of ~49%
Achieved the ROI almost from day 1 of the RPA implementation
Improved and standardized operations; defragmented processes
Improved efficiency through RPA and process transformation
New avenues for automating the future processes with limited changes to the client’s current environment
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