Sagility Optimizes Insurance Claims Processing System with Rapyder’s Gen AI Solution

Client:

Sagility

Introduction:

Sagility Health, a division of Sagility, is a global leader in business process management (BPM) and optimizing the member/patient experience within the healthcare industry. Formerly a part of Hinduja Global Solutions, Sagility is a tech-enabled BPM services provider and a trusted thought partner offering a wide range of transformational services to enhance efficiency and quality of care across the healthcare system.

Business Need:

The customer requires a streamlined, efficient solution to accelerate insurance claim processing. They are seeking an automated system capable of generating multiple-choice questions and flowcharts from insurance policy documents. This solution aims to significantly reduce processing time while improving the accuracy and consistency of claim assessments.

Implementation:

To meet the customer’s requirements for faster and more accurate claim processing, a generative AI-powered solution was implemented using AWS services, with the following steps:

1. Automated Claim Workflow Setup
   The entire claim processing workflow was automated, reducing manual steps and utilizing generative AI and AWS tools to significantly cut processing time.
2. Targeted Question Generation Configuration
   Leveraging Bedrock Anthropic’s Claude model, the solution was configured to automatically generate multiple-choice questions from policy documents, ensuring relevance to specific procedures and conditions for improved claim accuracy.
3. Interactive Flowchart Development
   Dynamic flowcharts were created to respond to user inputs, guiding claim handlers through a structured workflow for eligibility checks and the next steps in processing.
4. Customization Feature for Flexibility
   A customization feature was implemented, allowing users to define rules and examples to tailor generated questions and flowcharts, providing adaptability to various claim requirements.
5. Data Security and Compliance
   Robust data security measures and compliance protocols were incorporated to ensure the secure handling of sensitive information throughout the claim process.

Industry:

Healthcare

Offering:

GenAI

AWS Services:

• Amazon EC2,
• Amazon Bedrock (Claude Anthropic Models),
• S3,
• CloudWatch,
• AWS Lambda

Reaping Rewards:

1. Scalable, Cost-Effective Data Lake: The customer benefited from Delta Lake, built on AWS S3, which provided a scalable and cost-efficient data lake solution.
2. Optimized Data Handling: A custom logic in Delta Lake enabled inserts, upserts, and deletes without data duplication, ensuring data integrity for the customer.
3. Significant Time Reduction: Processing time dropped from 6–8 weeks to just minutes, delivering a substantial boost in operational efficiency for the customer.
4. Enhanced Accuracy in Claim Processing: Leveraging a generative AI model, the solution delivered more accurate and relevant questions, reducing errors in the customer’s claim assessments.
5. Cost Efficiency: Automation lowered labor costs and shortened turnaround times, yielding significant cost savings for the customer.
6. Automated Job Scheduling: Automated scheduling of migration jobs reduced manual efforts, allowing the customer to operate without human intervention.
7. Improved User Experience: The streamlined process enabled faster, easier insurance claim processing for medical practitioners, enhancing customer satisfaction