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How To Improve Healthcare Appeals Through RPA

by sol-admin

Learn how a major U.S. healthcare coverage administrator improved its appeals experience with WorkFusion RPA: reduced manual work by 85%, achieved 99% accuracy and cut processing time 5X – from 15 to 3 minutes.

Before Automation
Every time when members submit a policy complaint or want to appeal a decision, one of several teams must review the case. Appeals are requested via email, fax, phone, or through a web form. Information, including member name and complaint type, must be manually entered to start the appeal process. That’s the time when errors and any slowdown of an appeal can cost significant time and money.

The operations team at the company used WorkFusion Intelligent Automation Cloud to automate that manual process. First, Automation Cloud extracts data from emails using RPA and OCR and then uses machine learning models to classify and route requests into queues. Efficiency plus accuracy is achieved via an exception-handling workflow that includes a human-in-the-loop step for anything the bots are initially unable to process, such as handwriting.


  • RPA reduced manual work by 85% across the process end-to-end, from data extraction to policy decision
  • Timestamp and other data extracted at a 99% accuracy rate, up from 62%
  • Average routing time cut from 15 minutes to 3 minutes

You can download this case study here.