Client: An American healthcare products and insurance company
Headquarters: Minnesota, USA
Legal Status: For-profit managed company
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Several different business areas were running on outdated systems.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.
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
- 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