Case Study: Major U.S. Health Care Company achieves 85% workflow automation and faster appeals routing with WorkFusion

Improving the Healthcare Appeals Experience Through RPA

Major U.S. Health Care Company, a major U.S. health care coverage administrator, needed a better way to handle policy complaints and appeal requests arriving by email, fax, phone, and web form. The process was highly manual, requiring staff to enter member details and complaint information by hand, which was time-consuming, error-prone, and could delay appeals at significant cost.

WorkFusion implemented WorkFusion Smart Process Automation to automate data extraction, classification, and routing across the appeals workflow, with human-in-the-loop handling for exceptions like handwriting. As a result, WorkFusion reduced manual work by 85%, improved data extraction accuracy to 99%, and cut average routing time from 15 minutes to 3 minutes.