Client Background

Client: An American healthcare products and insurance company

Headquarters: Minnesota, USA

Legal Status: For-profit managed company

Employees: +300,000

The Challenge

Slow, inaccurate claim validations were increasing customer attrition, inflating costs, and draining revenue streams.

• Multiple legacy claim systems
  Several different business areas were running on outdated systems.
• Inefficient processes and communications
  Certain business areas were using SharePoint, emails, and manual spreadsheets to manage claim submission and validation.
• Lack of standard knowledge base
  Assistance for claims agents was inconsistent.
• Limited visibility
  Oversight of agent and team performance was limited, especially on the organizational level.

The Solution

Wipro proposed a comprehensive CSM-based solution with flexible, modernized internal systems.

• Standardized claim submission and validation process through one system and one architecture, across all the business areas
• Dynamic, automatic workflow orchestration Single product prioritizes workflows and routes them to agents based on skill and availability
• Automated productivity tracking Personalized dashboards and reports
• Enhanced claim processing Alert and escalate requests based on SLA and OLA

Business Impact

• Customer satisfaction Improved with more efficient claims validation
• Productivity Increased with greater visibility, and automated prioritization and routing
• Operational efficiency Increased with greater visibility of agent productivity, aiding in capacity planning and forecasting
• Revenue streams Restored and leaks mitigated by reducing the number of false claims processed through standardized approval processes