HyperHack-2024_Empowering Agents with AI: A New Era of Claims Processing

[Guhaneshwar]

HyperHack-2024_Empowering Agents with AI: A New Era of Claims Processing

Use Case Description

In claims processing, 20% of cases flagged as exceptions require manual intervention, as these cases cannot be resolved by auto-adjudication due to discrepancies or complex rules. Agents must validate these exceptions against up to 100 Standard Operating Procedures (SOPs) to determine the next steps. This process is time-consuming, error-prone, and often results in SLA breaches, particularly for less experienced agents. Our solution integrates UiPath’s RPA capabilities with an AI-powered assistant to streamline this workflow. The Bot extracts exception cases, queues them in UiPath Data Services, and populates relevant data in a UiPath Apps interface. Agents can process these exceptions or rely on the AI Assistant, which analyzes edit numbers, scans SOPs, and provides step-by-step guidance. This approach reduces resolution time by up to 80%, improves accuracy, enhances SLA compliance, and minimizes manual effort, ensuring consistent and efficient exception handling.

AS-IS WORKFLOW, TO-BE WORKFLOW

Other information about the use case

Industry categories for this use case: Healthcare Pharma

Skill level required: Advanced

UiPath Products that were used: UiPath Studio, UiPath Apps, UiPath Assistant, UiPath Data Services, UiPath Orchestrator

Other applications that were used: API,Open AI

Other resources: -

What is the top ROI driver for this use case?: Accelerate growth and operational efficiency