Industry landscape

Healthcare insurance covers essential health benefits that are critical for maintaining health and treating existing illness and/or accidents. It also helps protect people from the financial burden of an unexpected medical bill, provides preventive care, and is required by law.

A patient’s safety and quality care are crucial, as well as administrative services like billing. There are numerous medical policies with varying rules and regulations in different states as well as different plan designs -- causing back-and-forth queries from different healthcare platforms.

Today, the slow diffusion of medical knowledge and some medical information explosions account for some of the challenges facing the healthcare sector. Maintaining accurate and confidential data is a key strategy for quality data and operations management.

Client background

This client is a major healthcare insurance company in the United States and has a longstanding partnership with Wipro. The organization has more than 70 million subscribers in the United States and handles insurance for major groups. Wipro Philippines supports multiple lines of business from the client side and is handling a significant portion of their voice profile as well as their claim transaction profile.

Opportunity

• Data is not available during technical research while taking actual calls with several tools to open
• Manual files are not giving visibility and don’t identify areas that need work
• No real-time support is provided due to SME unavailability

Solution

• A machine learning tool that has predictive text when searching FAQs
• Capability for multiple code searches on client tools (codes specific, i.e. CPT Codes/ Dx)
• The ability for users to check real time process updates on the main screen
• A tool that provides a large amount of information for each code searched
• Easier access combining capabilities of both libraries and commercial sites
• Ideas suggestions for users (previously only SOPs were provided)
• Acts as virtual subject matter experts for more complex queries

Business Impact

• Helped in increasing accuracy due to knowledge gaps
• Productivity improvement of 20%
• Improved product knowledge due to available repository
• Reduced transfer rates by 16%
• Reduced SME count by 10% during the launch of the tool

Customer Testimonial and Awards

“Wipro has been a stellar business partner with constant communication each step of the way. We are in the process of sharing some of the best practices learned from Wipro’s achievement with our internal sites. They have made a significant improvement and we are very pleased with the results.“

For more information please reach out to amit.kale@wipro.com