Payer Operations
Claims Processing Automation
Demo video — coming soon
The Problem
Claims processing at a major BlueCross BlueShield plan relied on repetitive manual steps — routing, verification, data entry across legacy systems. High volume, high error rate, expensive to staff, slow to adapt to rule changes.
The Approach
Identified the highest-volume, lowest-judgment steps in the claims workflow and built RPA automations to handle them end-to-end. Focused on the processes where human accuracy was already bottlenecked and automation could match or exceed it without introducing compliance risk.
The Outcome
Automations. Reduced manual touch time per claim, translating to meaningful dollar savings per claim touch and hundreds of thousands in annual savings.
Stack
- RPA platform
- Claims core systems
- Audit & logging
- Change-control process