At a glance

An automation AI solution that makes phone calls using robots and Ring Central; process the IVR voice information received for the patients’ Health Plan eligibility and update systems using the validated information.

Outcomes

  • 4,200 calls handled by 15 bots per day.
  • 100% validation performed with zero human touch.
  • 8+ FTE cost savings

When Healthcare comes first

Before COVID, the client received approximately 800 calls daily, which were processed by its support team. One of the key activities was validating members’ Health Plan claim eligibility. This time-consuming and very repetitive task was done manually by agents. On average, 90% of members have no Health Plan coverage.

With COVID, this increased to ~4,200 calls per day — a difficult work volume for the support team to manage.

They were looking for an automated solution to help them filter invalid claims so their agents could focus on processing calls for eligible claims.

Smart solutions for automated calling and value addition

UiPath Robots call 800 number provided by Health Plan for verification, using Ring Central, provide client related inputs and capture the IVR response in the form of a voice file generated which is stored in AWS storage. This voice file is processed using a voice-to-text AI/ML module and the patient’s coverage status is extracted from audio file. The status is updated in the target system by the UiPath Robot.

Automating for efficiency and cost savings

Using 15 bots in parallel, 4,200 calls were processed daily. The bots also performed 100% of the validations with zero human touch.

This scalable solution helped with cost savings to the tune of 8 FTEs in resource optimization.

Why Eviden

Eviden has proven expertise delivering intelligent automation and has strong partnerships with leading commercial automation products including Automation Anywhere, Blue Prism, Celonis, Microsoft, Signavio and UiPath. In addition, we have a leading portfolio of IP-based tools and accelerators that deliver value to your business.

The client

Based in the United States, this client provides healthcare cost management solutions, specializing in providing claim cost management solutions for controlling financial risks associated with medical bills.

It also offers primary preferred provider organization (PPO) network solutions for accessing hospitals, ancillary care facilities, and healthcare professionals in the US.

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