Case Study

Health Insurance

  • Challenge

    Reimbursements of insurance payments have to occur in a timely manner according to § 62 SGB V. This results in a massive workload for the health insurance company at the beginning of the year, which cannot be solved by hiring additional resources due to the complexity of rules. Automation is expected to streamline the process, shortens processing time so insurants do not have to wait, without increasing human resource requirements.
  • Solution

    In an evaluation project reimbursement applications were processed via OCR and RPA. OCR is used in the SPS solution in order to capture the data from the claims, proofs of income and proofs of payments as well as other documents and provided to the robot. The robot processes the data according to the defined business rule. After checking by the data, it is transferred to the health insurance system. All processing is documented and the customer service employee receives a report with suggestions in order to finalize the transaction.

  • Benefits


    • Automated rule-checking ensures high accuracy
    • 50 % reduction in manual tasks
    • Cost reduction due to less human resource requirements
    • Shorter processing time results in higher customer satisfaction

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