Simplifying Enrollment with RPA

MaryBeth Folger News

Alishah Novin teaching technology concepts to students

The annual enrollment period (AEP) has a significant impact on yearly revenue for healthcare payers, but it can also tax an organization’s workforce substantially. During the annual enrollment period payers are hit with an influx of new enrollments to be processed. AEP runs for 6 weeks per year and billions of dollars’ worth of choices are made over this short time period. These choices directly impact the health and well-being of the millions of Americans signing up for benefits, so it is imperative that payers have the capacity to handle enrollment volume. Unfortunately, many payers struggle to quickly scale operational capacity, as any business would, which can lead to expensive overtime, overtaxed employees, and unhappy members.

In recent years, the healthcare industry has embraced automation as a means of addressing the unique challenges they face. It is no easy feat to keep operational costs under control while also providing a positive experience for members. Robotic process automation (RPA), supported by Artificial Intelligence, can shift the burdens created by enrollment off of employees to help you control costs and maintain member satisfaction.

Here are four ways payers can utilize RPA:   

  • Enrollment: When a health plan application is submitted, an enrollment specialist must manually take steps to process the administrative cost per plan, validate the data, and enter it into the enrollment system. This is a time-consuming process for even one member, let alone the millions of applications received during AEP. Robots can be trained to perform the same actions as an enrollment specialist and process enrollments around the clock to reduce the need for overhead and prevent any backlog.
  • Claims processing and adjudication: Claims and Provider Maintenance processes are also ideal candidates for automation. Utilizing robots to process and adjudicate healthcare claims is particularly valuable in enrollment season when payers want to free up as many employees as possible. Processes that previously took hours or days can be completed by robots in a fraction of the time. Reducing human errors and claims cycle time can also have a positive impact on provider and member relationships.

    A Blue plan with 3.5 million members was able to process more than 64,000 claims in less than 8 days with a 96% success rate with HPA’s automation. Overall, this client has saved more than 250,000 hours of manual work, the equivalent of 119 full-time employees. During seasons of high volume like AEP, some of these employees could be reallocated to more urgent work.

  • Data processing: Robots can monitor incoming enrollment data and begin processing as enrollments are received. With robots entering data into the system and processing new enrollments as they are entered, humans are freed from the robotic work to spend more time answering member questions. Robots can also be utilized to run enrollment data audits and send enrollment information to new members.

  • Member services: During AEP, call centers are overburdened with members calling in with questions or concerns about their health plan choices. Artificial intelligence capabilities like text-to-speech and natural language processing (NLP) can help transfer callers to the right department or line to reduce member wait times. Additionally, AI-based chat robots can help members solve issues entirely online, eliminating the need to connect with a live person.

RPA can also provide payers with valuable insights into their business. Unlike humans, robots can analyze large data sets to extract business intelligence and make it actionable. These insights highlight key areas for performance and operational improvements, informing leaders on where to best focus their efforts to generate the most lift.

Learn more about healthcare automation.