THE CLIENT
A leading healthcare organization is dedicated to providing compassionate, high-quality care to its members. Serving over two million individuals across the United States and employing more than 4,500 professionals, the organization prioritizes member well-being and continuously seeks innovative solutions to improve services.
OBJECTIVE
The client embarked on a strategic initiative to modernize and streamline its healthcare operations using intelligent AI automation. Their objective was to reduce manual workloads, increase accuracy, and accelerate clinical processing times for high-volume, document-heavy workflows.
CHALLENGES BEFORE AUTOMATION
The client’s healthcare operations involve thousands of document processing daily, such as claims, invoices, prior authorizations, clinical notes, and vendor communications. The client struggled with:
01
Scaling a Member-First Experience
Rapid growth made it difficult for the client to consistently deliver high-quality, member-focused service without improving operational efficiency.
02
High Volume of Healthcare Documents
Processing of large quantities
of healthcare documents
became overwhelming for
existing manual workflows.
03
Overburdened Claims and Utilization Management
Teams struggled to review and manage the growing volume and variety of incoming documents.
CHALLENGES BEFORE AUTOMATION
04
Complex, Varied Document Sources
Documents arrived from vendors, providers, and members in multiple formats, creating complexity and slowing processing.
05
SLA Compliance Challenges
Manual processing and increasing workload made it difficult to meet required service level agreements.
06
Labor-Intensive Manual Processes
Document review and data extraction required extensive manual effort, causing delays, bottlenecks, and quality issues.
THE SOLUTION: INTELLIGENT AUTOMATION PLATFORM
USM deployed a combined RPA and AI-powered solution with
human-in-the-loop validation and centralized analytics.
KEY CAPABILITIES INCLUDED:
Intelligent Intake
Documents arriving via email, portals, scanners, and shared folders are automatically captured.
AI-Based Classification
Documents are identified asinvoices, claims, authorizations, clinical forms, etc.
Validation
Low-confidence fields are routed for human review.
Auto Data Extraction
AI extracts required data fields with high precision.
Automated Posting & Routing
Clean data is sent directly intothe client’s operational systems(claims, finance, CRM, clinical).
Monitoring & Reporting
Dashboards monitor throughput, exceptions, and accuracy to ensure continuous improvement.
RESULTS
The automation solution has significantly improved quality, speed, and consistency, enabling better patient and member services while laying the foundation for future digital growth. Our tailored AI solution effectively addressed all the client’s challenges, delivering measurable operational improvements:
50%
reduction in manual effort for repetitive administrative tasks.
90%
improvement in data and process accuracy and consistency.
75%
faster turnaround times while maintaining compliance and quality.
92%
increase in auto-adjudication of medical claims.
Business Impact
◦ Staff redirected toward higher-value patient/member support activities
◦ More consistent service delivery and improved internal efficiency
◦ Scalable operations without proportional increase in headcount
◦ Strengthened digital foundation for future automation initiatives
START WITH YOUR HIGHEST-VOLUME WORKFLOW
Book a 30-minute working session. we map one process, size the automation opportunity, and show you the comparable build. no commitment.
50% less manual effort · 92% auto-adjudication · 90% accuracy lift
OUR LOCATIONS
ASHBURN(HQ) | FRISCO