Automated Claims Operations

Case Study

Automated Claims Operations


A leading health insurance firm was spending up to 6 days processing high-value claims, through a series of manual and human-led activities. By adopting automation the processing time frame was reduced from 6 days to 15 minutes.


A leading health insurance firm wanted to optimize the processing of high-value claims by:

  • Compressing processes while optimizing costs
  • Reducing manual data verification and repetitive tasks
  • Reducing the turn around time for claims processing


Achieved end-to-end automation by analyzing information from multiple sources and then updating the audit worksheet of the high-value claims.

  • Data Fusion & Computer Vision extracted the data from claims documents
  • With NLU analyzed doctors? notes to determine the root cause and then further classify whether the cause might be self-inflicted or criminal
  • Created a prediction model for claims? the outcome to aid auditors in finding discrepancies
savings in audit worksheet preparation
savings in claims audit effort
0 min
average processing time for a high value claim, reduced from 6 days