Business process automation helps health insurance provider handle explosive growth

Situation

The Affordable Care Act spurred exponential growth for a large healthcare insurance plan provider. Thousands of new applications flowed in. To maintain their reputation as an industry leader and to create great customer experiences, the provider needed to quickly and reliably streamline their processes.

Challenge

In addition to managing the application volume, healthcare plan documents also needed to be created in a more efficient manner. Their existing processes were manual and repetitive, requiring support from temporary staff, Quality Assurance (QA), Legal, and other teams. Unfortunately, these processes didn’t scale. So, the provider needed a modern, streamlined solution that met regulatory requirements and allowed transparency with audit trails, quality, and a reduction in redundant, repetitive work.

Solution

A Nintex partner built three custom applications and used Nintex Workflow to connect them into a cohesive, automated system that included:

  • Document generation: Built on SharePoint with .NET, this application lets the provider generate up to five different documents with a single configuration of a healthcare plan.
  • Document management: This application, also built on SharePoint with .NET, processes and distributes approved healthcare plan documents to different vendors and customer portals.
  • Advanced task management and document generation: This application provides advanced task management and document generation for a related area of the business. This app integrates with SharePoint to bring the tasks, records, and documents back into the environment, allowing further downstream processing and distribution.

Benefits

This new system allowed the company to avoid extra work and had an extensive positive impact on the business, including:

  • More than 300% reduction in time spent on document generation and approval
  • Quality Assurance increased its effectiveness by 75% and reduced approval time from five days per document to less than one day per document
  • The provider reduced temporary hiring
  • Customers received their documents in 14 days instead of 30 days
  • Customer service improved dramatically with automated processes and reduced processing time

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