Managed care company doubles down on automation, unlocking exponential value and transformation potential
Organisations in the managed healthcare sector contend with ongoing claims payment challenges, among many others. Fragmented systems, manual claim auditing, payment errors and tedious reporting drain countless employee hours, and relentless regulatory demands bring pressures daily. As a result, managed care companies are understandably thirsty for ways to relieve the claims audit burden, even as many of them are not sure where or how to obtain that relief.
The company was running dozens of manual claim reports. We were able to take those reports and consolidate them down into three Power BI dashboards. Once awareness about the capability of Power BI spread throughout business departments outside of claims audit, it created a buzz of innovation throughout the organisation.
With each phase of the project, the company added greater and deeper automation and intelligent technology, seeing value skyrocket. Efficiency and coverage increased year-over-year. Employees were enabled to review claims faster and take on more value-added tasks. Back-end interfaces were used to streamline processes and expand bots to additional states. Protiviti engaged the company in multiple design thinking sessions to determine how the current bot implementations could be applied to more use cases.
Claim auditors had been using tedious Excel spreadsheets and ineffective PowerPoint slides to track and report errors, whereas today, Power BI is used to weigh, score and evaluate errors.
While efficiency increased exponentially, the company also gained agility and flexibility among its employees. As monotonous tasks were automated, employees are able to take on value-add activities, diversify their skills and perform higher-level, more interesting responsibilities.
Visibility was heightened — instead of testing samples of data, the company is leveraging its new technology to evaluate full populations of data sets to uncover all errors rather than only the outliers in a sample population.
A Fully Transformed Claims Audit Function
Starting with a small RPA pilot — but dreaming big — the claims audit function has transformed itself into a deeply automated and highly efficient function which engages daily with bots, dashboards and weighted analyses of claims, seeding benefits across other departments, from operations to finance and internal audit. The substantial benefits include:
- Reduction in manual effort
- Significant increase in claims audited per year
- Decrease in audit time from ten minutes to six seconds per claim
- Higher rate of error identification due to increased coverage and root cause remediation
- Reduction in adjustments due to errors identified for larger populations
Teamwork Brings Success
The company banked on Protiviti’s deep expertise in the managed care sector and the success that came from the initial five-bot implementation. Thanks to a deep understanding of the company’s environment, its processes and its people, Protiviti and the company were able to scale the automation initiative to other areas of the organisation - from audit and operations to compliance and HR. Design thinking exercises facilitated by Protiviti helped the client see the possibilities and connect their organisational dots. More than a single function success, the organisation has seen its own significant potential for transformation with automation and data analytics.
We promote and support connected communications. We tell clients, ‘Here’s what your other functions are doing — have you communicated with them? We think we can pull their data and tie it together to streamline the process.’ Being a multi-service firm with deep industry knowledge and a history of providing value across a variety of services allows us to deliver that kind of broad, cross-functional value.