As a leading health insurance provider headquartered in the US, serving more than three million members and ranking among the top insurers in its state, this organization offers a diverse portfolio of health plans and services. As part of its mission to expand access to primary and mental healthcare, the insurer invests heavily in digital innovation to enhance service delivery, reduce costs, and improve the overall member experience.
Manual Processes Slowing Down Service Delivery
Despite the investments in digital transformation, the organization struggled with legacy processes for handling members and provider requests that relied heavily on paper forms and manual workflows. This approach introduced significant inefficiencies, delays, and elevated administrative overhead. With increasing demand for faster, more reliable services, the lack of digitization began to impact both operational performance and customer satisfaction negatively. Recognizing the urgency to modernize, the client set out to implement a digital-first solution to streamline form intake, reduce manual touchpoints, and improve processing speed and accuracy.
Brillio was selected as the partner of choice for its deep healthcare domain expertise, global delivery capabilities, and proven success in deploying AI-driven digital transformation solutions. With extensive experience working with Fortune 100 healthcare payers and providers, Brillio brought a domain-led, KPI-driven delivery approach tailored to the client’s goals.
Intelligent Workflows Built on Appian and AI
Brillio’s consulting-led deployment began with a comprehensive assessment of the client’s existing workflows, laying the foundation for a strategic transformation roadmap.
The deployment focused on end-to-end digitization, leveraging Appian’s process modeler and AI-powered automation to deliver scalable, secure, and compliant workflows. Seamless Pega integration and self-service portals ensured stakeholder adoption while enhancing service quality and reducing reliance on legacy systems.
Brillio designed and implemented a fully digitized workflow, leveraging Appian’s low-code platform to enable seamless digital form submissions and intelligent document processing. The solution automated form categorization, validations, and confidence-based document recognition through Appian’s ICR/OCR capabilities while integrating with Pega for end-to-end workflow automation. AI-powered enhancements, including document classification, sentiment analysis, and predictive analytics, further streamlined decision-making.
Brillio’s capacity-based POD delivery model provided a clear and scalable solution. Key roles, such as a BPM Analyst/Scrum Master for gathering requirements and a BPM Technical Lead/Solutions Architect to ensure best practices, played a crucial part in this. This model allowed for flexible resource scaling, sped up implementation, and promoted ongoing process improvement.
65% Faster Processing, 80% Less Manual Work
The intelligent workflow significantly reduced manual intervention, enabling faster processing and higher accuracy in resolving member and provider requests.
The solution delivered substantial, measurable outcomes. Operational efficiency significantly improved, with an estimated 65% reduction in average processing time from submission to resolution and over 80% reduction in manual data entry. The initiative is projected to reduce overall administrative costs by more than 50% by eliminating paper-based processes, optimizing storage and resource utilization, and lowering communication overheads.
Data accuracy improved markedly, with a 30% decrease in processing errors, while the scalable platform architecture supported ongoing growth without additional resource demands. Member satisfaction rose due to faster turnaround times, improved service visibility via real-time dashboards, and reduced support-related grievances. At the same time, security and compliance were enhanced through robust access controls, built-in audit trails, and adherence to HIPAA and other regulatory standards.
