Transforming Benefit Booklet Operations with GenAI Led Automation

Industry

Healthcare

Location

United States

Our Contributions

GenAI Solutions, Intelligent Document Processing, Workflow Optimization, Operations Excellence, Quality Governance, Managed Services

Health insurers manage highly complex benefit structures across multiple lines of business, where accuracy, timeliness, and compliance directly impact member experience. As benefit plans evolve and regulatory demands increase, manual processes often struggle to keep pace, leading to delays, quality issues, and operational strain.

To address these challenges, leading healthcare organizations are turning to intelligent automation and GenAI-driven solutions to streamline benefit operations, reduce reliance on manual effort, and ensure consistent, high-quality outcomes at scale.

The Challenge

The healthcare payer faced significant inefficiencies in its benefit booklet creation process, driven by a combination of process, technology, and people‑related constraints. Manual effort dominated operations, resulting in high turnaround times, elevated average handle times, and inconsistent execution across lines of business due to disparate process manuals.

Technology limitations further compounded these challenges, including non-standard IT processes, limited system integration, the absence of matching rules, and no automation. Heavy reliance on experienced resources, inadequate staffing levels, and long training cycles increased operational risk, leading to quality defects, rework, and growing member dissatisfaction.

Our Approach

Coforge implemented a holistic transformation approach across process, technology, and people, combining GenAI capabilities with strong operational governance to drive efficiency, accuracy, and scalability.

Process Transformation

Established single‑level accountability through complete ownership of assigned work queues. Implemented structured workflows using a flexible workflow platform to enable end‑to‑end visibility, reporting, and priority management, supported by a robust quality framework and transaction monitoring.

GenAI Powered Automation

Deployed Coforge’s GenAI solution, powered by the Coforge GenAI engine, to ingest, interpret, and extract benefit information at scale. Trained large language models to deliver near‑perfect extraction accuracy while enabling seamless integration with downstream systems.

People & Governance Enablement

Optimized job descriptions to deploy highly experienced resources, supported by knowledge banks, checklists, and process maps. Introduced weekly governance and monthly management reviews to continuously monitor performance, improvements, and adherence to quality standards.

Impact to Date

The GenAI-driven transformation delivered measurable improvements in productivity, accuracy, and operational resilience, while significantly reducing reliance on client teams.

↓ 75%+

Reduction in Processing Time

100%

Accuracy Achieved

Zero Backlogs

Operational Stabilization

100% Ownership

Reduced Client Dependency