About the Company
Driving Operational Excellence in Claims Management
Business Challenge
The client faced several critical challenges:
High Volume Processing
Managing high volume of cases and examinations annually demanded streamlined and automated processes to ensure timely resolution.
Complex Claims Triaging
Dynamic validation and verification of 100+ attributes across claims required advanced automation to expedite processing and minimize errors.
Appointment Management
Efficient scheduling and routing of medical examinations based on specialty needs, ensuring optimal provider alignment and secure medical report transfer.
Automation Needs
From auto-generation of Questionnaires to automated appointment extensions based on real-time data, the client sought to integrate comprehensive automation across their claims administration processes.
Solution Approach
Infinite devised a robust solution leveraging cutting-edge automation technologies:
Claims Triaging and Validation
Implemented dynamic validation algorithms to verify over 100 claim attributes, ensuring accuracy and compliance with regulatory standards.
Automated Assignment and Reassignment
Developed automated workflows for reassigning claims based on complexity levels and batch processing capabilities to optimize workload distribution.
Appointment Scheduling and Management
Integrated intelligent routing algorithms to match examinations with suitable providers based on specialty needs, with automated scheduling and rescheduling functionalities.
Communication and Collaboration
Implemented context-aware chat functionalities for seamless communication with providers, alongside notifications and alerts management to ensure timely updates and scheduling changes.
DBQs Generation and Management
Automated the generation of Disability Benefits Questionnaires (DBQs) and calendar management, triggering additional examinations based on real-time responses and needs.
Invoice, Audit, and Reporting Automation
Enabled auto-generation of invoices, integrated audit workflows, and provided access to real-time and historical data for comprehensive reporting.
Outcomes from Infinite’s Solution
The implementation yielded significant results:
Enhanced Operational Efficiency
Automated processes reduced manual intervention, resulting in faster claims processing and reduced error rates.
Improved Provider Collaboration
Context-aware communication tools facilitated seamless interactions with providers, enhancing collaboration and service delivery.
Optimized Appointment Management
Automated appointment scheduling and extension functionalities streamlined logistical operations, ensuring timely and efficient medical examinations.
Comprehensive Dashboard and Alerts
Management dashboards provided real-time insights into claims status and performance metrics, supported by proactive alerts and notifications for critical updates.
Cost Savings and Efficiency Gains
Achieved significant time savings across various processes:
- Significant time saved in triage verification
- Reduction in scheduling time through automation
- Huge time savings for providers with billing automation
- More than half time saved in DBQ generation and completion
- More than half reduction in QA and review efforts
Employee Engagement and Strategic Insights
Improved employee engagement by shifting focus from transactional tasks to judgment-intensive skills development. Provided analytical insights to senior leadership for strategic decision-making and best practice extraction from high-performing departments.
Driving Innovation, Delivering Excellence
Partnering for Continued Success