With over 30,000 employees and a presence on five continents, this leading multinational insurance company is the largest in Latin America. More than 30 million people worldwide rely on it for the health services they need. For an insurer, it is essential to ensure that patient care is delivered correctly, with a valid and consistent history. The challenge lies in achieving this goal within the appropriate timeframe to reimburse providers as agreed, without errors and with maximum visibility of the process.
The variety of document formats presented a challenge when trying to implement traditional solutions that would reduce processing time, requiring sustained resource investment to meet deadlines.
75% of documents are received in the last 10 days of the period, leaving very little time for the claims and finance team to organize payments.
For these reasons, the company implemented the Alfred platform, capable of ingesting data without format limitations, understanding the inputs, and providing an almost immediate response without human intervention.
The original process required manual intervention for each claim, with a series of repetitive steps that consumed the time of more than 40 agents per shift in the department.
Tagshelf delivered an end-to-end automated platform with the flexibility to adopt business rules without requiring technical investment from the insurer. In addition to the main process, Alfred’s AI models analyze stamps, signatures, dates, and other features to identify invalid claims, preventing 100% of fraudulent claims and providing an additional layer of security in the process.
Results
Alfred enabled the company to reduce the time needed to process claims by 80%.
- 80% reduction in the time to complete claims.
- 25% cost compared to the original process.
- 100% prevention of fraudulent claims.
The significant reduction in processing time has not only improved operational efficiency but also opened new market opportunities. Alfred’s ability to analyze data accurately and efficiently offers the possibility of establishing more beneficial agreements and strengthening business relationships.
With Alfred, the insurer is better positioned to face future challenges and continue providing high-quality health services. As a next step, the insurer plans to implement an automatic enrollment process to integrate new members more quickly and efficiently, further enhancing its ability to offer innovative solutions and maintain its leadership in the industry.
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