Claims Processor Increases Efficiency Through Targeted Retraining

Situation

The core business function of a claim’s processor is to review pending claims and pay out approved claims to the providers that rendered that service. The diligence and regularity of individual reviewers have an important impact on the success of their business through the volume and quality of their reviews.

Approach

AArete’s rithmiqAI extracted data from a vast array of workflow systems to track individual “touches” of claims, tying the individual’s work to the stages of the claims adjudication process. 

Using the Effort Model, the standard effort is compared against the performance of individual analysts to assess high and low performers in terms of their overall productivity and effectiveness in a specific area.

Results

In an operation of 50 back-office claims staff, rithmiqAI identified 10 FTEs (20%) that could increase their claims processing throughput with targeted up-skilling and focused retraining.