Case Study

UST SmartOps helped health insurance company automate claims operations with intelligent document processing, eliminated 92% of manual work effort

We integrated UST SmartOps low-code automation platform with this health insurance company’s existing claims processing applications to analyze information from multiple sources and update audit worksheets for high value claims. The solution eliminated 92% of the manual work effort, accelerated claims processing from six days to just 15 minutes, and saved 70% of audit worksheet preparation time.

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CLIENT

Our client is a leading healthcare provider dedicated to improving lives and communities through innovative health benefits and services. By leveraging data-driven insights and comprehensive health plans, the company aims to deliver personalized and effective healthcare solutions to millions of individuals and families across the United States.

CHALLENGE

Complex, manual tasks bogged down insurance claims processing cycles

The company's existing manual claims processing system struggled with the volume and complexity of high-value claims. Reviewing dependent documents and scanned images was labor-intensive, leading to delays and errors in processing. The company sought an intelligent automation solution to streamline workflows, reduce processing times, and improve accuracy.

TRANSFORMATION

UST SmartOps solution provides end-to-end intelligent automation to accelerate claim reviews

We deployed UST SmartOps, an AI-powered process automation solution, to provide a comprehensive approach to automate and optimize claims operations. Leveraging intelligent document processing (IDP) capabilities, the system assimilated and analyzed information from multiple sources. It efficiently extracted data from scanned claims documents and updated audit worksheets for high-value claims.

Automated validation mechanisms were implemented to apply complex business rules accurately. Detailed reports provided insights into claims auditing, enhancing transparency and compliance.

IMPACT

Nearly 100% acceleration in claims processing cycles

After the successful UST SmartOps business process management software deployment, the healthcare insurance provider achieved these results:

92% savings in claims auditing effort—since efficiency gains drastically reduced manual effort and improved overall productivity
70% savings in audit worksheet preparation—thanks to automations, which enabled resource allocation optimization
15-minute average processing time for high-value claims—from six days to just 15 minutes, ensuring faster turnaround and enhanced customer satisfaction

RESOURCES

https://www.ust.com/en/smartops

https://www.ust.com/en/smartops/services

https://www.ust.com/en/industries/healthcare-and-life-sciences