| Payer organizations
are challenged to decrease the labor intensive
pend claims process. Industry statistics reveal
20-40% of Claims are suspended or pend.This results
in high transaction costs per claim, increased
call center activities and opportunity for human
error. Any automation for this requires replication
of activities of a claims processor, integration
with claims adjudication systems and rules configuration.
Wipro’s pend claims automation solution
is built on business process management platform
and it interacts with the legacy workflow system
to retrieve pend claims that need to be worked,
then interacts with the core adjudication system
to retrieve the necessary data to work the claim.
Then replicates the exact activities undertaken
by the claims examiners to determine the actual
resolution to the pend.
Features
Configurable rule engine:
Business rules and process’s can
be changed with ease.
Inference engine:
Auto processes pended claims
Benefits
 |
Lower transaction cost per claim |
|
Increase cycle
time |
|
Decrease call
center load |
|
