Simplifying claims processing with AI

A real-world challenge


Processing claims can be time-consuming. When our client, a U.S. health insurer, needed help turning around claims reviews quickly and accurately, they turned to us for help.

 

Meaningful solutions


With 40 million members, our client had many healthcare claims to process. At the time, 13% of claims were being manually processed, and it was clear that automation would help improve speed and accuracy.  

Utilizing AI technology, machine learning, and natural language processing, our team developed the Digital Claims Examiner (DCE). This proprietary AI technology effectively sped up claims processing and reduced errors. DCE also helped human claims examiners refocus their time and expertise on complex cases. 

Ultimately, our solution created annual savings of over $4 million with far fewer claims requiring manual adjudication.