Reduced processing time by 98 percent and increased throughput by up to 40 percent by moving from batch to real-time claims processing.
The Client & Category
An organization processing thousands of insurance claims daily was constrained by legacy batch workflows and fragmented data pipelines. Claims processing could take up to 20 hours, limiting the ability to identify discrepancies in a timely manner.
The process relied heavily on manual review, which constrained throughput and introduced inconsistencies in data quality.
The Solution
We implemented a real-time claims intelligence platform that automates ingestion, validation, and anomaly detection across high volumes of claims. The platform processes claims continuously, applying a comprehensive set of configurable rules to detect discrepancies across billing codes, diagnoses, duplicates, and member data. It also standardizes and enriches data to create a consistent and reliable foundation for downstream workflows.
It also standardizes and enriches data to create a consistent and reliable foundation for downstream workflows.
The Outcome
Processing time was reduced by 98 percent, from approximately 20 hours to 20 minutes. Manual review effort decreased by 50 to 70 percent, while claims throughput improved by 30 to 40 percent. Discrepancy detection increased by 2 to 3 times, enabling faster intervention and improved overall accuracy.
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