Managing Healthcare Claims With RPA – Outsoured Medical

As medical insurance claims continue to rise, healthcare insurers are constantly looking for ways to optimize new technology that will automate critical tasks and improve efficiency. The objective for these rebuilt processes are to increase speed, reduce risks and improve accuracy in handling claims. Robotic Process Automation (RPA) is the key to meeting these objectives and increasing the rate of automation for claims processing in the most cost effective way.

Healthcare claims that require manual processing or human intervention have an average cost of $5 to process while automated claims costs less than $1. There are billions of medical claims filed each year in the United States alone so increasing the automation of claims by just a small percentage can make a significant positive impact to an insurance company’s bottom line.

RPA technology uses digital robots and software to automate the review and resolution of healthcare claims. While the traditional auto-adjudication systems will only check for accuracy an RPA can resolve claim issues and automate the entire process. Many auto-adjudication systems today utilize some type of RPA extension to process healthcare claims. Introducing an RPA system capable of replacing the work of five human employees can cost as little as $10,000 per year.

The most common reason for insurance companies to convert their claim management tasks to RPA is for the savings in processing costs. By completely automating the majority of claims the RPA allows humans to focus more of their time and effort for researching specific regulations and policies for complex and unusual claims. Most people assume RPA simply replaces human resources but they actually benefit everyone involved in the healthcare claim process.

Benefits of Using RPA for Healthcare Claims

  • Improved Accuracy and Quality. Studies show that anywhere between 3-5% of medical claims have errors caused by either “fat-fingering” or complex fraudulent activities. RPA will get that number to 0% by either completing the entire claim process in itself or just assisting the quality assurance team in scanning huge amounts of data and transactions for accuracy. RPA speeds up the process after the First Notice of Loss (FNOL) by automatically notifying those involved and integrating all claim information to improve customer experience.
  • Maximize Efficiency. RPA relieves people from having to do time consuming mundane work like processing routine claims and handling data entry tasks. Employees involved in claim processing can focus on more valuable areas like managing exceptions and figuring out complex and high-risk claims. Health insurance companies have greatly increased efficiency by having RPA support straight-through processing for claims under a predetermined dollar amount. Turnaround times for these type of claims have historically been reduced by 80% by eliminating 70% of the those repetitive tasks involved in processing a claim.
  • Increased Scalability. It is natural for their to be ups and downs in workload and seasonal spikes when in the health insurance industry. RPA makes these shifts in workload easy to manage since there is no need for overtime and with a flip of button can be operating 24/7. The ease of scalability with RPA gives health insurance companies the option to explore shared services models to save even more on their operating costs.

The time has come for all healthcare insurance companies to adopt RPA in order to stay competitive. Implementing a true end-to-end automation system for medical claims will greatly enhance performance and bring on more value for the insurer. A significant number of companies are already using RPA to manage their healthcare claims and experiencing tremendous benefits.

Please leave comments about how RPA manages healthcare claims:

Published by Zack Williamson

Zack Williamson is a co-founder and CEO of, a remote staffing and business management consulting firm with offices and partners in the US, UK, The Philippines, New Zealand and Australia. Zack enjoys writing about a wide range of topics from business process consulting and International manpower logistics to digital media and internet marketing. That being said, some people visit his blog to check out the occasional rant about politics, health, music and more.

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