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Claims Process Automation


This case study delves into the automation endeavors of a healthcare company based in America, focusing on their claims processing department. The company aimed to enhance operational efficiency and minimize errors in data processing through cutting-edge automation techniques.


  • Handling a daily volume of approximately 1700 claims resulting from the auto-adjudication process.
  • Identifying and automating processes that require significant manual effort.
  • Mitigating errors stemming from human data processing on claims.


  • Utilized Agile methodology for incremental and iterative delivery.
  • Identified high-volume scenarios in claim backlogs for prioritized automation.
  • Implemented iterative automation, starting with the Happy Path (MVP).
  • Refined automation logic based on iterative feedback.
  • Developed multiple small robots for various scenarios like authorizations, COB, ER, and claims intake.
  • Implemented centralized monitoring and reporting for robot execution.

Business impact

Number of Processes Automated
Number of BOT Deployed
Total BOT Execution Time
Number of Claims Processed (Daily)


Throughout this case study, the healthcare company successfully navigated the challenges of processing a high volume of claims and reducing errors in data processing with the adoption of innovative automation solutions. Ennuviz's expertise and advanced process mining technologies played a crucial role in guiding the company through this transformation journey. By providing valuable insights, guidance, and support, Ennuviz experts facilitated the identification of automation opportunities and the optimization of various processes. Ultimately, the collaboration with Ennuviz empowered the healthcare company to streamline operations, enhance efficiency, and significantly reduce manual effort, leading to improved overall performance and customer satisfaction in their claims processing department.