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 MCM claims with medical cost savings are recorded in a database and validated post payment. Paid claims are published in a report to be sent for validation. Claims are reviewed to verify medical cost savings actualized and then completes specific fields in the database to finalize medical cost savings.

Solution

The monitoring and execution of tasks were automated using AssistEdge RPA based on business rules. The automated tasks that run on software bots are easily scalable as per business needs. Automation enabled consistency of output even with a large customer volume of claims.

Outcome

Enabled processing of ~ 8000 claims weekly through automation

63% claims processed with zero-touch

Bots operated nearly 23 hours in a day, enabling processing a large number of records in a single day

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