Overview

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

CBS receives a list of priority claims to be worked upon or alternatively, CBS may pull up claims from different bins. CBS then works on claims by validating data across multiple applications. If required, CBS may redirect the claim to different units for further processing after updating details.

Solution

AssistEdge Engage provided three different search options so CBS could work on the claims (Claim ID, Member ID, and Get Next Claim). Also provided one-click automation to route claims to different units and rolled out across 70+ users.

Outcome

Enabled processing 100+ claims in a single day

Increased productivity by 10%

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