Case Study: U.S. Health Insurer achieves 60% reduction in Medicare audit costs and clears 51,000-claim backlog with Atos

Health insurer automates and standardizes processes to clear Medicare audit backlog and reduce costs by 60%

A leading U.S. Health Insurer was struggling to comply with Medicare rules for maximum out-of-pocket (MOOP) payments after two backend claims systems fell out of sync, creating a two-year backlog of unaudited claims with no prioritization or scalability. The insurer engaged Atos (Atos Syntel) to audit the backlog, analyze the broken manual processes, and recommend improvements using Knowledge Process Outsourcing (KPO) services.

Atos deployed a process expert for due diligence, built and trained an offshore KPO team in Pune, and cleared 51,000 audits in three months. By standardizing workflows, capturing process data and automating error‑prone tasks, Atos reduced cost per audit by more than 60%, saved $1.3 million, increased audit speed by 40–50% and lifted productivity ~45%, and continues to provide ongoing KPO support.