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Healthcare Payor's Claim Process Transformation

Claim Sense uncover innovative ways in process claims effectively and efficiently while keeping the cost optimized

Industry Pain Points

Healthcare payers are facing two major challenges in the current healthcare landscape. They need to ensure operational efficiency and lower the claims processing cost in a rapidly changing industry. About 20-30% of claims require manual handling, leading to "pending" statuses and additional fees. Furthermore, processing low-value claims is often more expensive than their actual value, which makes it difficult to decide whether to automate, auto-adjudicate, or handle them manually.

Per Claim Processing Cost
Average Claim Processing Time
30 Days
First-pass Claim Acceptance Rate
Average Claim Backlog
Claims Auto-adjudication Rate
Claim Denial Rate

Our Solution

Transforming Healthcare Payors' Claims Operations, our innovative approach swiftly addresses pending codes through comprehensive dependency insights. This method halves claim iterations, significantly reduces claim cycle time, and results in substantial cost savings. The outcome? A remarkable 12% decrease in operational expenses, highlighting the solution's ability to optimize Healthcare Payors' Claims Operations. Additionally, our solution achieves a 40% auto-approval rate for low-value claims, elevating claim operations to unparalleled levels of efficiency and effectiveness.

Uncover Pend Dependency
Uncover Pend Dependency
Leveraging cutting-edge Process Mining technology, our solution meticulously analyzes historical claim data, pend codes, and resolution steps to pinpoint specific pend codes and tailored resolution paths for each claim type and characteristic. This in-depth analysis equips Claims Operations with actionable insights and personalized guidance, streamlining claim adjudication processes for enhanced efficiency.
Streamlined Low-Value Claim Management
Streamlined Low-Value Claim Management
Our solution streamlines the processing of low-value claims by offering insights to guide decision-making on auto-adjudication or automation, reducing dependence on manual processes and ensuring a more efficient claims management system. This innovative approach helps payors realize substantial operational cost savings and improve auto-adjudication rates, resulting in a more efficient and responsive claims processing environment.



Cost Saved
Reduce Turnaround Time
Increase Auto-Adjudication Rate
Increased First-Pass Rate
Automatation Saved
18 FTE

Why Choose Us

50+ Years of Technology Expertise

Our wealth of experience has equipped us with the proficiency to deliver exceptional services to you.

4K+ Processes Modeled

We have effectively assisted organizations with capable process modeling to enhance productivity.

50+ Certified Consultants

Our team, with extensive knowledge, provides the best service and support to meet your needs.

1000+ Tasks Automated

We have successfully automated processes with enormous results benefiting the organization.

Strategic Services for Your Success

Discover our array of expert services crafted to boost your business. From tailored consultations to efficient technology management, we're committed to driving your growth and ensuring success in the digital realm.

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Here’s how to get started

Effortlessly unlock business success by connecting with a dedicated Advisor, receiving a personalized Technology Roadmap, and focusing on business growth with your technology needs in capable hands.

Schedule a Call

Talk with a dedicated Advisor who can help you assess your company so that you can know exactly what your needs are.

Get a Free Roadmap

After your call, we will send you a personalized Technology Roadmap to help you discover the solutions that are right for you.

Grow Your Business

Now that your technology needs are being handled, you can focus on running your business and staying ahead of the competition.

Let's started today

Because we put you first. Our customer-obsessed working model honors client's needs.

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