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How a US based Fortune 50 healthcare payer optimized its claims processing operations & enhanced overall customer experience

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November | 2019

Wipro delivered business value of $8 million to the client, together with 11% productivity improvement through automation levers

Client description

  • Client: A Fortune 50 US based Healthcare Payer
  • Industry type: Healthcare
  • Core Business: Healthcare services
  • Geography: Worldwide
  • Annual revenue: $226.2 billion (2018)

Challenge

Their existing claims processes had high dependency on employees leading to various challenges. High manual errors in the process were causing high rework. This inefficiency in the operations was leading to high Average Handling Time (AHT).

The process was leading to misquoted benefits to customers that further led to escalations and churn rate. This led to low Net Promoter Score (NPS) and CSAT due to human errors in the process queue.

Customers had to wait for a long time to reach an agent due to lack of channels for self-service and query resolution that resulted in high call abandonment rate.

Solution

Wipro used left shift framework involving automation and next gen tools and technologies to deliver value. We leveraged robotics, analytics and (Artificial Intelligence) AI to reduce human dependency in the current processes:

  • Faster issue resolution
    • Virtual expert and code helper tools to assist employees and reduce manual work to focus on higher value tasks
    • Robots to assist in research
    • AI chat bots to answer transactional customer queries
  • Continuous optimization
    • Predictive analytics for sentimental analysis to boost NPSsks
    • Virtual auditors for better quality control by 100% sampling
  • Personalization
    • While chat bots answered transactional queries, complex queries were directed to experienced subject matter experts

Business impact

How a US based Fortune 50 healthcare payer optimized its claims processing operations & enhanced overall customer experience

“By using Wipro’s automation solution, the customer achieved reduction in AHT by up to 20% for their operations”

- Suresh Nair, General Manager, Technology Services

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