Automating Insurance Claims-Processing for a Leading American Healthcare Company

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Several different business areas were running on outdated systems.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

Service Offerings