Case Study: Horizon BCBS of NJ achieves faster claims processing with Prolifics BPM

Horizon Improves the Health of Claims Processes with BPM

Horizon BCBS of NJ, one of New Jersey’s largest and oldest health insurers, needed a better way to handle the massive volume and complexity of its claims operations. With nearly 60 million claims processed each year, manual handling was causing delays, errors, and inefficiencies, while employees spent too much time on tasks that still required human intervention. Prolifics helped Horizon address these challenges through business process management and automation.

Prolifics implemented a BPM Center of Excellence and automated key processes, including straight-through claims processing and claims approval workflows. The solution improved visibility, streamlined workflow orchestration, and reduced claims processing time from 30 minutes per claim to one minute per 10,000 claims. As a result, Horizon achieved same-day claims processing for the first time, automated about four million previously manual claims, and realized a 3:1 return on investment.

Horizon BCBS of NJ