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

All claims with BA14 pend code had to be processed through a lengthy manual process. Claims had to be segregated as pending or sent for release based on business rules. The complexity of the process resulted in a lengthy processing time.

Solution

Automation incorporating logic of pre-defined conditions was implemented now to process all claims with an ability to pend or release the claim if needed. Bots run throughout all days, including weekends, with very little downtime.

Outcome

Enabled annual savings of ~$900K annually​

Eliminated all manual effort in the process

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