Challenge
Exela was entrusted with the critical task of verifying member eligibility for a leading healthcare provider. This process involves accessing a client portal hosted through Citrix, retrieving member records, cross-referencing three years of data against the member plan, updating member details, and submitting the updates. This labor-intensive operation is not only costly but also prone to errors and delays, posing significant challenges to operational efficiency.
Solution
To overcome the challenges associated with manual processing and ensure seamless member eligibility verification, Exela deployed its RPA (Robotic Process Automation) automation platform. This solution revolutionized the workflow without disrupting the client's existing systems or processes. Scheduled bots were implemented to aggregate data and apply validation rules to determine member active status. The aggregated data was then presented to quality assurance specialists for verification, ensuring accuracy and reliability. This automated process was repeated for every claim awaiting processing, significantly enhancing efficiency and streamlining operations.
Benefits
Achieved over 20% cost reduction through automation, leading to substantial savings.
Ensured 100% quality level in member eligibility verification, minimizing errors and discrepancies.
Increased productivity by eliminating manual tasks and accelerating processing times.
Enabled faster turnaround, enhancing responsiveness to member needs and improving overall service delivery.
Seamless integration of automation technology preserved the integrity of the client's existing systems and processes.
Enhanced scalability and flexibility to adapt to evolving business requirements and fluctuating workloads.
Improved employee satisfaction by relieving staff from repetitive and tedious tasks, allowing them to focus on higher-value activities.
Discover What Exela's Eligibility Verification Solution Can Do For You
