Case Study: Global Insurance Company reduces medical claims leakage and projects $60M annual savings with Cognizant

Automation and Expertise Plug the Leaks in Medical Claims Costs

Cognizant partnered with a global insurance carrier that was facing rapidly rising workers’ compensation medical costs—medical benefits had more than tripled since 2003 and the insurer was experiencing medical-claims leakage of 7–9% annually. Traditional cost-containment methods such as bill review, utilization review and nurse case management were failing to stop the losses, so the carrier sought a new, strategic approach.

Cognizant implemented OptimaMedWise™, a customizable treatment-plan engine combined with trained clinical staff to provide medical-necessity review as a service: clinical activities are validated against injury-specific plans, every claim is automatically reviewed, and exceptions are routed to registered nurses. In six months the program identified $50M in excessive or unnecessary claims, projects $60M in annual savings, and allowed 40% of claims to be processed automatically as compliant—reducing medical costs while maintaining care and outcomes without raising loss-adjustment expenses.