A leading healthcare payer in the US, celebrated for its dedication to superior service, was grappling with substantial challenges in customer service and claims processing. The use of multiple disconnected customer service applications led to inconsistent user experiences and high call transfer rates. Additionally, their outdated manual claims processing system caused high error rates and lengthy processing times, adversely affecting customer satisfaction.

• Operational Inefficiencies: The fragmented support structure caused delays and inconsistencies in resolving customer issues and processing claims.
• High Costs and Errors: The internal development and maintenance of custom automation solutions, coupled with the support team’s overhead, led to increasing costs and high error rates.
• Talent Shortage: Finding and retaining professionals with the necessary skills in AI and automation proved challenging, hindering innovation and process optimization.

Our ‘Rapid AI Factory’ model is a unique approach to help our customers adopt AI technologies 3x faster than the traditional approach. This model gives access to various different AI technologies and different skills to our customers ‘in a box’ model. This model is operated on a fixed monthly subscription based model and delivers 3 to 10 AI solutions every month.

Why ‘Rapidd AI Factory’ Model?

• Accelerated implementation with 60% faster TTM
• 40%-60% improved decision making
• Faster ROI realization, within 6-8 months
• 30% of additional cost savings
• No upfront huge capital investment
• Convergence of Emerging Techs in a box.

AI solutions across the Healthcare Payer value chain

• Claims Adjudication: Automate claims data processing, Detect fraudulent claim patterns
• Prior Authorization: Automate prior authorization review, Predict common authorization approvals
• Underwriting: Insurance application processing, Risk assessment, Insurance pricing.
• Intelligent Chatbots: Self-Service for Members, Initiate basic member transactions.
• Contact Center Automation: Case processing, Auto-email response, Auto ticket creation and resolution.

• 30% Reduction in Claims Processing Time: The automated claims processing system led to a 30% reduction in processing times, improving operational effectiveness and customer satisfaction.
• Zero Error Rates: The new system virtually eliminated errors in claims processing, enhancing accuracy and reliability.
• 5% Reduction in Monthly Denials: The advanced automation solutions led to a 5% reduction in average monthly denials, improving overall service quality.
• 30% Lower Call Transfer Rate: Within three months, the call transfer rate for the contact center was reduced by 30%, enhancing customer satisfaction and reducing operational costs.
• 70% Reduction in First Call Resolution Times: The average first call resolution times in the member contact center were reduced by 70%, significantly improving the user experience.

Collaborating with Rapid AI Factory changed the healthcare payer’s approach to managing its customer service and claims processing operations. The streamlined support functions, combined with advanced AI-driven automation solutions, not only boosted operational efficiency but also enabled the company to focus on its core mission of delivering exceptional healthcare services. Partnering with Rapid AI Factory allowed the healthcare payer to maintain its competitive edge, improve service quality, and ensure sustainable growth.