BPM for Healthcare & Insurance

Business Problem

In an effort to provide health insurance coverage options across the country, a case management system was needed that could handle tasks including the intake, routing, review, and troubleshooting of applications submitted through the mail for enrollment.

Process Players

Employees that determine eligibility of paper applications submitted

Process Steps

BPM allowed us to accept documents from an FTP folder and automatically create individual tasks from each document. Employees determining applicants’ eligibility then select the status of a new application which triggers the workflow – placing tasks into the appropriate user’s queue. When inconsistencies are detected in the data, employees are able to make ad hoc changes to the workflow based on their observations. Emails and paper documents are automatically created to notify applicants of additional clarifications required.

Process Benefits

By adopting BPM, we were able to create a case management solution that met all the requirements for managing up to 50,000 paper applications per day. Resolving inconsistencies found in individual applications has been completely automated. Built-in real-time analytics offers complete visibility into process performance, allowing for continuous optimization and improvement in cycle times.