success story

US-based TPA giant optimizes claims processing


The client reduced over 15 million calls in a year with Virtusa’s claims processing solution

The client is a leading global provider of technology-enabled risk, benefits, and integrated business solutions, located across 65 countries. They aim to simplify claim processes and reduce complexity, making it easy and effective for all stakeholders.

The Challenge

The client wanted to provide a seamless experience to their customers but faced difficulty reducing claims handling time and achieving faster time to decision. They addressed their client’s needs with manual customized approaches that consumed a lot of time using the examiner as the hub and coordinator for the workflow.

The client wanted to automate many routine tasks to save the examiner's time.

The Solution

Virtusa suggested feather touch claims which eventually empowers the customer to actively participate in the claim process (either through web or mobile). After evaluating and consolidating all the services rendered, the basic tasks were automated through a powerful workflow solution, and only complex tasks were routed to the examiner for manual reviews.

The client thus implemented processes with a high-end solution, including pre-filled data and drop-down options for most customer information. This left less for customers to add claim notes and important points to avoid errors and mistakes.

The approach reduced redundant and unnecessary data entry. The implementation was done through an agile methodology following an Accelerated Solution Design (ASD) approach with concurrent use of multiple sprint teams, each working with time-boxed DCO, building and testing each sprint's phases to ensure accuracy.

Claim processing solution
The Benefit
Our domain-led technology solution for 24/7 customer service helped: 
  • Enhance operational efficiency with many processes converted to straight through processing
  • Reduce routine calls by 15 million a year 
  • Optimize examiners time by addressing only complex issues
  • Achieve superior customer delight by drastically reducing manual data entry resulting in a steep increase in claim settlement ratio


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