A major US health insurer was struggling to efficiently create benefit documents for millions of members across multiple states. They needed a strategic partner to streamline document workflows and ensure compliance, so they turned to Coforge for help reinventing the process with AI.
Transformation Timeline
Drag
The Challenge
The client was manually creating benefit booklets and Summary of Benefits and Coverage (SBC) documents for its members. With hundreds of templates for different states and employer groups, this manual process was making the enrollment cycle inefficient and prone to errors.
Creating the booklets had a steep learning curve. It required experienced staff to manually extract data from multiple unstructured document formats, a slow, resource-intensive process that could not be scaled during peak enrollment periods.
Human errors and inconsistent validation also created a very real risk of falling out of compliance with regulators.
Our Approach
Coforge built and deployed an AI-powered document automation solution designed to accelerate benefit booklet processing and improve compliance. Built on the Quasar AI platform, the solution leveraged automation and AI-enabled features to accelerate the process and improve quality.
Gen AI-Powered Entity Extraction Template Recognition
LLMs were trained to ingest, interpret, and extract the relevant data, then select the right document template for healthcare plan types like PPO, HMO, or HSA.
AI-driven ETL Workflows
AI agents were responsible for structuring and validating benefit data for members.
Human-in-the-Loop (HITL) Model
Instead of executing highly repetitive tasks, human efforts were saved for refining the final documents and ensuring high quality output.
Automated Compliance Checks
Each document was validated for alignment with CMS and state regulations before delivery.
CMS Integration
The solution was integrated with the client’s existing content management systems to enable seamless downstream processing.

Impact to Date
75%
95%
100%
Business Impact
- Backlogs eliminated and overdue items resolved
- Effective integration with downstream systems
- Significant reduction in dependency and workload
- Seamless inter-departmental connectivity across lines of business
- Dynamic, flexible operating model that supports peak periods
The new, AI-driven system successfully manages multi-state document variations and employer-specific formats, enabling scalable and repeatable automation.
The client now has a production-grade automated document generation pipeline that performs during peak enrollment periods and supports continuous improvement and long-term compliance readiness.
