Case Study

HGS Employs Automation to Drive Significant Savings for International Payer

Digital Transformation




 Buyers of contact center services expect BPO providers to proactively pitch innovative operations, cost-containment, and customer experience ideas on an ongoing basis. Outsourcers that bring and actively use cutting-edge technology (such as, robotic process automation and analytics) are better equipped to offer continuously increasing value. According to the 2016 Everest Contact Center Outsourcing Annual Report, HGS is one of the only outsourcers offering analytics, automation, and interaction services. Since 2003, a U.S.-based, top-five healthcare payer actively working to balance member cost per month with better member outcomes, has turned to HGS for BPO savings and improvements. To deliver continuous value to this treasured client, HGS recently introduced robotic process automation (RPA), and major changes are underway within some of this client’s central lines of business.



  • Robotic process automation (RPA) for surgery claims and authorization-related calls
  • Involves 500+ agents delivering provider customer care in three countries (Philippines, U.S., Jamaica)
  • Part of a decade-old business process outsourcing relationship with 4,600 agents in four countries
  • RPA is yielding AHT, retention, cost, and CSAT improvements.



RPA is a non-invasive technology solution that uses a client’s existing end-user interfaces and enterprise applications to reduce agent effort. This solution employs screen scraping, workflow management, task automation, data extraction, clipboard, and keyboard shortcuts. RPA does not store any data, require the Internet, or involve a major IT-driven client-server deployment; it is typically implemented on a local user machine.

HGS suggested several RPA methods for reducing the overall call-handling time for provider customer care (PCC) queries. Over the years, calls had increased in complexity and duration, and metrics were challenging to meet due to the introduction of new products, transaction types (such as, claims status, eligibility, and benefits), and systems and interfaces. PCC agents effectively became super-agents, handling an extremely steep learning curve and a broad array of transaction types. This led to staffing issues and negative effects on research time, handle times, number of resolutions, level of agent and customer effort, and the satisfaction score. The client agreed to an automation project expected to improve the provider and agent experience.

HGS provided dedicated RPA resources to lead the project. The RPA team scoped out a phased approach over a six-month period. The RPA team obtained security clearances and installed a third-party real-time (RT) designer tool to drive the automation project. (The RT designer is automation software deployed on the presentation layer of a client’s customer relationship management [CRM] platform for solutions design. The RT designer queues tasks, monitors process completion, and allocates robotic resource assistance.) Security for RPA is typically straightforward to implement, as it does not copy, extract, or transmit any enterprise-related data; require any replication or migration of existing databases; or require any new development.

“Qualitatively and quantitatively, RPA has clearly taken the pain away from complex provider customer care transactions. Using technology to the fullest has improved metrics and relationships (clientvendor, agent-customer, and employer-employee) and transformed this business line. Both HGS and the client are excited to apply RPA to other transaction types.”

PK Kalra SVP, GGSM-Solutions & Capabilities HGS Inc.

Once installed and configured, HGS used the RT designer to simplify and automate the steps to resolve provider issues. The RPA solution deployed included:

  • Real-time notification – Flags out-of-scope calls Workflow-based automation – Guides the call flow based on claims status
  • Decision-making tree – Decides application usage on predefined business rules Screen element capture – Extracts and populates claim data
  • Knowledgebase search – Searches thousands of on-screen claims status and reimbursement explanation codes
  • Terminal emulation – Validates authorization requirements in mainframe systems using business rules
  • Real-time analytics – Provides business intelligence for performance improvement

The solution was thoroughly tested at the systems, algorithm, and user acceptance (experienced and inexperienced agents) levels. The pilot solution was implemented in the Philippines initially and then applied in the US and Jamaica. Each existing agent now receives a half-day of extra training to build trust in automation, to learn to interact with systems, and to complete the steps that have not yet been automated; RPA exercises are also included in the agent initiation training for new hires.


“Robotic process automation has extraordinary potential in the front and back office. After sharing details of this RPA continuous improvement story with other clients, we can hardly keep up with the demand and inquiries. Both existing and new clients want to implement RPA in their programs right away.”

Siby Joy, VP, Account Management & Solutions (Healthcare) North America - HGS Inc

OUTCOMES For this client, HGS combines desktop application and process analytics, real-time guidance and decision-making, and process automation to get the right answer fast for client partners.

While still in early days, the indicative automation results are estimated to save the client $700,000 per year, via AHT reduction:

  • Surgery eligibility calls — According to three different scenarios, automation may save between 20 and 80 seconds per call (accounting for an 8% to 17% average handle time savings), depending on the scenario.
  • Claims authorization calls — Per those three scenarios, HGS automation solution may save 42 to 82 seconds (or 13% to 15% time decrease), depending on the scenario.

The client is already seeing improvements in call quality, as well. In fact, HGS has recorded quality improvements from the original 98.19% to the resulting 99.01%.

Additionally, agent retention is improving overall (5% improvement since inception), as the job is less stressful when technology shoulders some of the decision, research, and lookup burden. One agent sums up the impact concisely – “RPA helps me in research, data extraction, and after-call documentation. It’s like a virtual friend at work always there to help me!” Longer tenured agents ensure proprietary, tacit knowledge, and culture are maintained.

Because of the significant project success, including estimated annualized $700,000 cost savings and security clearance, the client is eager to explore other automation projects. HGS is keen to implement automation and offer continuous improvement and innovation ideas to clients. As such, the HGS team is actively working with the client to apply RPA to other lines of business.


What is RPA?

Robotic process automation (RPA) is an advanced technique for reducing costs, increasing speed, improving accuracy and quality, providing scalability and capacity, and accessing analytics. It introduces smart software into process and task completion to mimic human actions on a machine using a variety of rule-based scripts.

RPA selection considerations:

  • Efficiency improvement
  • Risks and risk reduction
  • Potential for end-to-end automation
  • Quality improvement
  • Business disruption
  • Human resource type
  • Customer experience
  • Process and system stability
  • Reusability
  • Complexity
  • Sponsorship and support
  • P&L impact

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