Case Study

Health Insurance

  • Challenge

    No insurant likes to wait for long to get reimbursed for insurance payments. But these complex transactions cannot be handled by using seasonal workers.Short-term seasonal workers lack the necessary qualifications and experience to significantly support the team.

    Additionally, the risk of errors rises if people who lack business experience are involved. Therefore it has been necessary to put a lot of effort into training and quality assurance in the past. Applications for hardship cases at the beginning of the year therefore require the health insurance company to offer intelligent solutions.

  • Solution

    Robotics provide a real alternative, as a current extensive evaluation project is demonstrating in which Swiss Post Solutions (SPS) is working with the health insurance business. 

    OCR is used as the first step in the SPS solution in order to capture the data all the incoming documents, and to provide them to the robot in a structured format. If all required data is available, the robot starts processing the data according to the defined business rules. Rule-based checking by the robots occurs externally and the data is transferred to the health insurance system afterwards. All processing is documented and the customer service employee receives a report with suggestions in order to finalize the transaction.

  • Benefit

    • The robot is able to read very different poofs of payment and recognize de relevant data.
    • The robotic solution allows a 50% reduction in manual processing, which shortens the complete processing time.
    • The insurants receive their reimbursement faster, leading to higher customer satisfaction, and at the same time less additional resources are required. 
    • The robot shortens the transaction time, ensuring higher accuracy and reduced process costs, just through the validation of data delivered by the OCR, according to the specified rules and the transfer of proven data into the health insurance system.

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