AgentHack submission type
Enterprise Agents
Name
Mansi Bhatnagar
Team name
Accenture Agentic Squad
Team members
mansi.a.bhatnagar@accenture.com,u.t.ravichandran@accenture.com,harsha.purushothama@accenture.com,y.rajendra.pingale@accenture.com,
How many agents do you use
Multiple agents
Industry category in which use case would best fit in (Select up to 2 industries)
Healthcare Pharma
Complexity level
Advanced
Summary (abstract)
Smart Health Claim Assistant Agents helps in categorizing huge amount of incoming claim related emails-
Provides responses to received queries
Validate if the incoming email is valid or not
Analyzes Patient’s data from PM App and data from reports and bills attached in the email and takes decision whether the claim can be filed or not.
Calculates eligible dispense, files claims and send follow-ups to customer in case of missing information
Detailed problem statement
Insurance Claim process in Healthcare domain is a vast scenario and requires analysis of multiple data points in order to check-
If the issue is valid or invalid. Many decisions need to be taken up, for example if the customer is eligible for the claim, checking tenure of insurance if its enough to cover the issue, since this process is a very sensitive process.
Human needs to analyze multiple source of information. Refer huge unstructured documents to take decisions, Interact with the customer in case of missing information.
All these unscheduled communications results in increasing the AHT of one single request and is difficult to keep record of.
Detailed solution
Our proposed UiPath solution will automate and streamline the Healthcare claims processing workflow by :
Maintaining claim wise instance in Maestro
Health Issue Identification Agent (Email Classification): Automatically receiving and classifying incoming customer emails related to health issues, identifying the type (accidental, medical, casual, query).
Advanced Data Extraction : Utilizing Intelligent Document Processing (IDP) to extract crucial details from attachments and patient management (PM) applications.
Patient History Analyzer Agent : analyzes extracted data, validate claim eligibility against patient plans, and provide a decision on claim processing.
Validate if customer/patient’s issue is covered under the plan
Validate if Claim is valid & can be processed or not (tenure)
Identify if any information is missing
Automated Dispense Calculation & Claims Entry Agent: A “Dispense Agent” will analyze and calculate dispense amounts, identify ineligibility reasons, and automatically enter all relevant details into the Claims Application.
Smart Follow-ups & Human-in-the-Loop: Automatically sending follow-up emails if no response is received and routing complex cases or missing information requests for SME (Subject Matter Expert) review or human intervention.
Automated Communication: Sending automated summary emails with claim IDs upon successful submission and rejection emails with specific reasons for invalid or incomplete claims.
Demo Video
Expected impact of this automation
This UiPath solution will revolutionize healthcare by bringing :
Visibility on status of a claim throughout its lifecycle using Maestro
Will reduce the time spent on analyzing huge medical and policy documents
Boosting efficiency, accuracy, and compliance in claims processing.
It will improve financial management and patient satisfaction through streamlined transactions.
Ultimately, it will reduce operational costs, enable scalability, and drive data-driven decisions across the industry.
UiPath products used (select up to 4 items)
UiPath Agent Builder
UiPath Apps
UiPath Document Understanding™
UiPath Maestro
Automation Applications
Sample ERP
Integration with external technologies
Anthropic Claude, Microsoft Office 365
Agentic solution architecture (file size up to 4 MB)
Sample inputs and outputs for solution execution
Inputs- Claim Filing emails, Bills, Prescriptions & Reports
Output- Email stating Filed Claim Number and the reason of Rejection/Success or any variation in dispersed amount