International Health Insurer

Challenge

The client’s existing process for pre-authorisation of treatment was a manual, multi-step process. The admin team would request specific information to pass over to an independent expert panel. Decision rules were in place, however there was a heavy reliance on manual checking.

With referral volumes increasing, customers were experiencing delays in decisions and the existing processes required additional resources to support increasing workloads.

Solution

psKINETIC utilised Appian to deploy a digital workflow and case management solution.

The solution delivered key features to transform the business process:

  • Single web portal where a case is managed by all stakeholders – administrators, operations management and the expert panel
  • Treatment specific algorithms and rules
  • Automated workflow to drive the process
  • Audit trail of activities performed on all cases to meet compliance requirements

Outcome

The solution was live within 3 months with the following benefits:

  • 60% reduction in admin time needed to support a case through the authorisation process
  • 50% reduction in response time improving customer experience
  • Controlled and consistent process