Case Study

Maximizing Value with RPA Innovation for a Major Payer’s Claims Processing


As one of the world’s largest healthcare payers, this HGS client works closely with brokers and consultants to develop innovative programs; help individuals and families improve their health, well-being, and sense of security; and lower their medical costs. The client identified claims processing as an area for improvement. Claims processing time was a significant pain point, so this leading health plan turned to HGS to provide tools customized to the client’s unique needs.

With all three processes in various states of launch, HGS estimates up to 50% cost reduction in EDI Member Enrollment and Member Eligibility and up to 50% cost reduction in Premium Collections. Additional benefits will include decreased turnaround time and decreased manual error. We have already delivered labor savings of approximately 60%, reducing staff from 25 to 10 team members. Additionally, we have significantly reduced TAT from 3.5 days to only three hours, a 96% reduction.