Streamlining Mediclaim Validation with UiPath RPA in the Insurance Industry
Client Background
A prominent insurance firm in the healthcare sector faced significant challenges in efficiently processing Mediclaim requests. Managing claims required meticulous validation of medical bills against the information submitted in claim forms, a process prone to human error and delays. The company aimed to enhance accuracy, speed, and efficiency by leveraging UiPath's Robotic Process Automation (RPA) technology.
Business Challenge
The insurance firm confronted several challenges in its Mediclaim validation process:
Manual Verification:Â Claims processing involved the manual validation of medical bills against claim forms, making it time-consuming and prone to human errors.
Mismatch Resolution:Â Discrepancies between the information on bills (e.g., hospital name, patient name, dates, and total bill) and claim forms required time-consuming investigation and reconciliation.
Approval Workflow:Â Due to the financial implications, an additional layer of manual validation was necessary before approving claims.
Document Variability:Â Medical bills arrived in different formats and layouts, making standard data extraction difficult.
Solution Overview
The organization implemented UiPath RPA with Document Understanding capabilities to automate the Mediclaim validation process. The RPA bot was designed to perform the following tasks:
Document Parsing:Â Using Document Understanding, the bot extracted critical data from medical bills, including hospital name, patient name, admission and discharge dates, and the total bill amount, despite the varying document formats.
Form Comparison:Â The bot compared the extracted data from medical bills with the corresponding data in the claim forms.
Mismatch Handling:Â If discrepancies were detected, the bot triggered an email to the user, requesting an explanation or clarification for the mismatched information.
Approval Workflow:Â When there was a match between the bill and claim form, the bot routed the claim to the "Human in Loop" for a final manual check and approval due to the financial implications involved.
Audit Trail:Â Every transaction was logged, providing an audit trail for transparency and compliance purposes.
Benefits
The implementation of UiPath RPA with Document Understanding brought significant benefits to the insurance firm:
Enhanced Accuracy:Â Automation significantly reduced human errors in the validation process, leading to more accurate claims processing.
Efficiency:Â The RPA solution expedited the claims validation process, reducing processing time and improving efficiency.
Resource Optimization:Â Claims processors could allocate their time to more value-added tasks, while the bot handled routine validations.
Compliance:Â The audit trail facilitated compliance checks and reporting, ensuring adherence to regulatory requirements.
Financial Control:Â The additional layer of manual approval added a control mechanism to mitigate financial risks.
Results
By utilizing UiPath's RPA technology with Document Understanding, the insurance company efficiently streamlined Mediclaim validation, achieving a remarkable 78% increase in accuracy while reducing errors. This automation showcased the power of RPA in managing intricate, document-heavy processes, even when dealing with non-standard formats, ultimately improving efficiency and financial control.