How we helped a leading health insurer hit high notes through auto-adjudication of claims
Our client, a multi-state health insurer, faced challenges in processing high volumes of claims, especially those exceeding specified lines and amounts, requiring manual intervention. This manual process led to delays and increased costs, impacting provider and member satisfaction. Infosys conducted an impact assessment, considering regulatory requirements and cost-benefit analysis. A strategic rollout plan for incremental automation, starting with dental claims, was implemented. This approach, accepted for its favorable ROI, addressed 80% of pending claims, ensuring operational efficiency. Infosys orchestrated value by improving auto adjudication by 3.88%, automating 21,000 additional claims daily, simplifying transactions for providers, and reducing MIPS consumption. The innovative approach streamlined operations, leading to enhanced reimbursement, stakeholder satisfaction, and optimized outcomes."
