AiRo Digital Labs is an award-winning boutique RPA shop. This use case showcases our RPA and Intelligent Automation implementation for Member Enrollment for a Healthcare Payer Client based in the US.

1. D I G I T A L L A B S
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Elevate Digitally
Experts in Digital 2.0 Transformation for Healthcare,
Pharma, Life Sciences and Manufacturing industries
USE CASE
RPA Implementation for Member
Enrollment for Healthcare Payers

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ABSTRACT
RESULTS
Member enrollment is a time-consuming process that is ridden with errors due to
manual processing of applications. Payers risk non-compliance if they don’t meet
mandated timelines and face revenue loss if they are unable to handle peak loads.
To enroll a new member, the analyst processes paper-based or scanned applications
– the task involves extracting relevant data from forms, validating the data and map-
ping it to corresponding fields in downstream applications.
In times of increasing digitization and automation, these numbers reveal that com-
panies are missing out on possibilities for making their operational processes more
efficient. Adopting emerging digital technologies, such as RPA (Robotic Process
Automation) and Cognitive Automation are being hailed as the new solution.
INDUSTRY Healthcare Payer
Operations
BUSINESS
FUNCTION
10,000+
35
ENROLLMENTS
PER MONTH
FTEs BEFORE RPA
76%
REDUCTION IN
TURN AROUND
TIME
$600K
ANNUAL SAVINGS ON ACCOUNT
OF PROCESS OPTIMIZATION, ERROR
REDUCTION AND REDUCED FTE
21
FTEs REASSIGNED
TO HIGHER VALUE
TASKS
ZERO
ERRORS
USE CASE
RPA Implementation
Member Enrollment

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THE CHALLENGES
Revenue loss of 10%, esp. if unable to handle seasonality affects (peak loads) due to Affordable
Care Act.
Additional infrastructure investments to handle different distribution channels (e.g. brokers,
exchanges etc.) and complicated incoming enrollment data formats (fax, physical forms).
A high number of discrepancies and exceptions on account of manual data entry, missing fields
lead to incomplete registration which further increases follow-up tasks and impact on overall
cost.
High risk of non-compliance mandated by federally regulated policy deliverance timeline (72
hours for ‘4Rx’, 7-day deadline from enrollment completion to CMS transmission) directly contrib-
uting to star ratings of payors.
Lowering margins created the need to optimize current business operating model and lower
bottom line.
Increased infrastructure investments required to enable quicker response from the slow legacy
systems of State & federal government.

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THE SOLUTION
OUTPUT
1- Successfully showcase of controlled
Robotics PoC
2- Automation potential assessment
3- Process candidate evaluation and
prioritization
1- RPA Target Operating Model
2- Set of processes automated
and migrated to Production
1- Self sufficiency at the client to run
the RPA service
2- Re-purpose the existing human
capital
4- Roadmap and project plan
5- ROI business case
WHAT WE AUTOMATE
IS A PROCESS
HOW WE AUTOMATE
IS A PROCESS
DECIDING WHAT TO AUTOMATE
IS A PROCESS
AIRO RPA METHODOLOGY - HIGH LEVEL ROADMAP
DISCOVERY RPA IMPLEMENTATION BOT COE
1-3 WEEKS
DUE DILIGENCE PoC RPA MOBILIZATION ENTERPRISE LEVEL
5-8 WEEKS2 WEEKS 4 WEEKS
Process assessments
Identify and prioritize
candidate process for potential
process automation
Evaluate and select RPA tool
Make summary report and
indicative business case for
process automation potential
Set up PoC & Production
environment
Prove the benefits of
automation by automating
a simple to medium
complex business process
Demonstrate automation
delivery methodology
Mobilize Process Automation
Program
Design phase
Build phase
Run phase
Bot development
Build robotics CoE for
consistent implementation
and support
Monitor, maintain and operate
robotics processes
RPA Helpdesk- Hypercare
1-
2-
3-
1-
2-
3-
4-
5-
1-
2-
3-
Business Analyst Robotics Factory TeamBusiness Analyst/Developers Robotics KT Team
Account
Set up
Enrollment/
Dis-Enrollment
Correspondence Welcome Kit Letter
Sending
Premium
Billing

5. We understand the risk points in the enrollment process and have carried out
robust mitigation techniques throughout the automation implementation
AiRo adopted its RAFD (Rapid Assessment Framework and Develop-
ment) methodology to automate the end to end member enrollment process and
provided insurers a scalable solution to process enrollment applications, with
considerably reduced cycle time. This makes the experience pleasant for the prospective
members and cost effective for the payers. AiRo utilizes ML and NLP algorithms to
auto-classify forms and extract relevant information. It also assigns confidence scores
for the extracted values, with the provision for the analyst to make any corrections to
extracted data. The validated data can then be exported to a chosen file format for
further processing.
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INFORMATION
PROCESSING
Individual or corporate customer
registration details replication
from the digital/manual form
to the payer’s system
Intelligent Automation with built-in
Machine Learning cleans up data for
error free and unbiased registration
The bot automates a calling list
creation for exception leads
Each field in the system is validated
with scanned documents using OCR
validated information is then forwarded
to the dispatch team to send
welcome kits and IDs to members
Validated data captured in payer’s
system is then auto triggered to CMS
With complete recording of information,
an email for the billed premium amount
is sent to the enrolled member
Collected payment confirmation is recorded
in the system and is added to the subfolder
as per desired bifurcation matrix
INFORMATION
SUBMISSION
CALLS TO
MEMBER
LETTER TO MEMBER
AND CMS
SEND DATA FOR
WELCOME KIT/ ID
INFORMATION
VALIDATION
PROCESS ACTIVITY RISK/ FAILURE POINTS
Incorrect/ Missing member details
Critical fields missed or incorrectly
captured
Enrollment/Disenrollment timelines missed
Process/regulatory requirements not
followed
TRR rejections
Missed out BAE information
Failed/Incorrect submission to CMS
Failed/Incorrect submission of PBM
eligibility data
Delayed submission to CMS
Unable to reach member
Wrong contact details
Reached voicemail
Incorrect information captured
Missed out some information
Incomplete/incorrect data sent to
printing vendor
Delayed data sent to printing vendor
Delayed correspondence to Member
Delayed CMS exhibit information to print vendor
Incorrect / incomplete correspondence to�
CMS vendor / processor
Delayed Bill generation to Member
Delayed cash application
Delayed correspondence to Bank/in house�
accounts team
Unable to interpret/comprehend customer
Delayed calls
Process/regulatory requirements not followed
Required information not provided to member
Printing vendor printed information incorrectly
Printing vendor missed out some kits
Incorrect / incomplete correspondence to member
Incorrect / incomplete correspondence to print vendor
for CMS exhibit
Delayed correspondence to CMS by Vendor / processor
Incorrect / incomplete correspondence to member
Incorrect / incomplete Cash application
Delayed submission of PBM eligibility data
Delayed submission for attestation
Failed to submit some transactions for
CMS attestation
Failed/incorrect processing of TRR records
Incorrect / incomplete verification of Member
LIS status
OHI Verification not done / inaccurate OHI
verification
Failed ot process out of area transactions
Failure to rectify erroneous activities / records
Failed to reinstate members disenrolled in error
BILL GENERATION
CASH APPLICATION
& RECONCILIATION

6. w w w . a i r o d i g i t a l l a b s . c o m
Processing time reduced by up to 75%.
Improved Star ratings of payers to the top 10 percentile in the industry with ensured
consistency and quality, 100% elimination of human error and 100% compliance.
43% increase in focus on customer facing/ engagement tasks due to reduced
repetitive tasks & Increased productivity with the increased enrolments/ hour and
24/7 operations.
Higher staff satisfaction by allowing individuals to focus on exceptions, escalated
cases and necessary human intervention.
Reduced TAT on new member enrollment applications by 76% - from 17 days to 4
days.
HIGHLIGHTS

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AiRo Digital Labs is an award-winning Chicago-headquartered, Digital 2.0 consulting
f irm, which is one of the fastest growing leaders in the f ields of Cognitive Automation,
Traditional RPA, Machine Learning, Natural Language Processing, Natural Language
Understanding, Deep Learning, Industrial IOT and other AI technologies. AiRo Digital
Labs partners with clients in industries such as Healthcare, Pharma and Life Sciences,
Manufacturing, Hi- tech and Retail / CPG to accelerate their business transformation by
using emerging technologies.
AiRo Innovation factory has created 30 automation prototypes ready for
implementation including the award winning “Employee Onboarding” bot.
These ideas deliver fast and high-quality solutions to everyday business challenges.
1000+ virtual workersBots deployed across the globe
Innovation Lab for rapid assessment of technology and developing prototypes
90%+ ROI on core processes HR, Finance, Procurement, Sales, Supply Chain, Operations
Developed virtual workforce to automate and simplify processes
D I G I T A L L A B S

8. D I G I T A L L A B S
CONTACT US
CHICAGO
GURUGRAM
1871- CHICAGO ENTREPRENEURSHIP CENTER
222 W MERCHANDISE MAR PLAZA #1212,
CHICAGO, IL 60654
AIRO DIGITAL LABS PVT. LTD.
9TH FLOOR, TOWER-B, SAS TOWERS, MEDICITY, SECTOR 38,
GURUGRAM (GURGAON), 122002, HARYANA
HO CHI MINH CITY
HO CHI MINH CITY LAB,
SAIGON HI-TECH PARK, TAN PHU WARD, DIST. 9,
HO CHI MINH CITY, VIETNAM
Website https://www.airodigitallabs.com/
Mail to jennifer.hawkins@airodigitallabs.com