Aetna Inc. (Aetna) is a US-based health insurance company, which offers health insurance plans and services, including medical, pharmaceutical and dental plans, Medicare plans, Medicaid services, Behavioral health programs, and Medical management.

Opportunity

All claims that pass through MCM with medical cost savings are recorded in a database and validated post payment. As claims are paid, they are published to a report showing they are ready for validation. The staff reviews the claims in the processing systems to verify medical cost savings, and then completes specific fields in the database to finalize the medical cost savings.

The client was looking to standardize handling/consistency of output, reducing the need for additional resources, thereby allowing the staff to focus on more complex claims. Due to extended hours of availability, the client was also looking to improve the volume of claim handling.

Solution

The client implemented AssistEdge RPA to automate business tasks, which are repetitive and rules-based. Thanks to AssistEdge RPA, the automated tasks that run on software bots are easily scalable as per business needs. The awareness of how the system and medical cost program changes impact automation allows the client to anticipate changes for the future.

Outcome

Weekly volume of 7900 claims verified
63% claims automated with no manual intervention
Claims now processed on time, without having to depend on resources
Easily extendable to additional bots and workflows

Learn more about AssistEdge RPA