Streamlining Healthcare Operations with Claims Workflow Automation

Product Development | Healthcare

Overview.

Automating Claims Management for Maximum Efficiency

A public healthcare provider partnered with Pegasus One to address inefficiencies in their claims management workflow. The provider’s manual system of forwarding claims between processing departments led to delays, increased costs, and frustration for both staff and members. Recognizing the high stakes of healthcare operations, Pegasus One developed a custom automation solution to transform their claims management process.

Workflow Automation | Real-Time Management | AWS Integration

Challenges.

Bottlenecks in Claims Management

  1. Manual, Time-Consuming Processes
    • Claims were manually routed between departments, causing unnecessary delays and reducing overall efficiency.
  1. Lack of Real-Time Insights
    • Supervisors relied on reports and spreadsheets, making it difficult to locate claims, track statuses, or prioritize urgent issues.
  1. Increased Penalty Payments
    • Delayed processing led to penalty payments that further strained operational budgets.

Approach.

Leveraging Workflow Automation for Healthcare Operations

Pegasus One’s .NET development team designed and implemented a custom workflow application tailored to the client’s needs:

  1. Real-Time Management Views
    • Replaced manual reports and spreadsheets with centralized, real-time management dashboards.
    • Claims supervisors could track claim statuses from a single, user-friendly interface.
  1. Automated Alerts for Critical Issues
    • Senior management received automatic alerts for urgent or problematic claims, ensuring faster resolution times.
  1. Streamlined Claims Tracking
    • Introduced automated claims routing and workload management processes to eliminate inefficiencies.
  1. AWS Expertise for Scalability
    • Leveraged our experience working with AWS development companies to build a robust and scalable solution that could grow with the client’s needs.

Results.

Delivering Tangible Value to Healthcare Operations

The implementation of Pegasus One’s claims workflow automation solution yielded significant results:

  1. Improved Productivity
    • Achieved a 34% increase in claims processing productivity, enabling the client to handle a greater workload with the same resources.
  1. Reduced Penalty Payments
    • Penalty payments decreased by 17% year-over-year, significantly improving operational cost-efficiency.
  1. Enhanced Member and Provider Satisfaction
    • Faster claims processing and reduced errors led to better experiences for both members and providers.
  1. Cost Savings and Operational Efficiency
    • Automating claims tracking and workload management reduced overhead costs while boosting overall efficiency.

Value Delivered.

Empowering Healthcare with Innovation

By automating claims management workflows, Pegasus One helped the client modernize their operations in a way that reduced costs and improved satisfaction across the board. The integration of real-time insights, automated alerts, and streamlined tracking processes transformed a cumbersome system into an agile, future-ready solution.

This project underscores Pegasus One’s commitment to leveraging technology to solve complex challenges in the healthcare sector, delivering solutions that drive measurable results and long-term value.