Claims Document Automation

Business Impact

• 38% reduction in average claims cycle time (submission to adjudication).
• 24% lower manual handling cost per claim.
• Improved data quality score from 82% to 97% via structured extraction.

Challenge

Incoming claims packets (PDF, images, emails) required manual review and keying. Variable layouts and handwriting reduced extraction accuracy and slowed downstream adjudication, creating backlogs and inconsistent SLAs.

Solution

Deployed a modular intelligent document processing (IDP) pipeline:

1. Document ingestion & classification (policy, medical, invoice, correspondence).
2. Layout & field detection using vision transformers + heuristic post‑processing.
3. NLP entity extraction & normalization (ICD codes, provider IDs, dates, currency).
4. Confidence scoring & selective human validation work queue.
5. Feedback loop writing disposition & corrections to active learning store.
6. Governance telemetry (accuracy, latency, drift) pushed to monitoring dashboard.

Architecture Highlights

• Containerized microservices on orchestrated platform with autoscaling.
• Feature store capturing document embeddings & token features.
• Model registry with versioned promotion gates & rollback policy.
• PII redaction service + encryption at rest & in transit.

Outcomes

Automation lifted straight‑through processing to 61% in 3 months (from 12%). Enhanced auditability reduced compliance exception handling effort by 30%.