A Fortune 25 U.S. Payer Improves Enrollment Efficiency and Reduces TAT by 50% Leveraging AI-Assisted Member Enrollment Optimization

Challenges

Process Complexity & Delays

• High complexity and volume in enrollment processes led to delays in application processing and coverage activation
• Increased turnaround times impacted customer experience and plan ratings

Quality & Rework Issues

• Manual processes resulted in documentation errors and rework
• High error rates affected compliance and operational efficiency

Workload & Capacity Constraints

• Ineffective prioritization and workload management led to missed SLAs
• Insufficient staffing and high dependency on experienced resources created backlog

Technology Limitations

• Multiple intake sources and fragmented data systems increased manual effort
• Absence of advanced matching rules and automation capabilities
• Distributed data across systems, spreadsheets, and workflows limited efficiency

Solution

Coforge implemented an AI-assisted Member Enrollment Optimization framework combining process, technology, and workforce transformation.

Process Optimization & Governance

• Streamlined enrollment workflows using AI-assisted process automation
• Established a robust quality framework with transaction monitoring
• Implemented structured prioritization and inventory management

Workforce Transformation

• Deployed experienced SMEs with a plug-and-play model
• Cross-trained resources to enable dynamic load balancing during peak periods
• Introduced a flexible staffing model for Annual Enrollment Period (AEP)

Technology Enablement

• Built an omni-channel intake model for multiple enrollment sources
• Implemented MIS and dashboards for real-time tracking and prioritization
• Enhanced reporting visibility for operational decision-making

Training & Knowledge Framework

• Developed structured training and certification programs
• Created Knowledge Banks, checklists, and process maps to standardize execution
• Enabled faster onboarding and reduced learning curve

The Impact

50% Reduction in Turnaround Time
Enrollment processing time reduced from over 4 days to less than 1 day within 6 months.

100% Quality Achievement
Consistently achieved near-perfect quality scores (99.99%), exceeding target benchmarks.

20% Productivity Improvement
Reduced rework and improved process efficiency led to higher workforce productivity.

15% Reduction in Manual Rework
Improved accuracy and automation minimized manual intervention and errors.

Faster Workforce Readiness
Reduced hiring-to-production time to 6 weeks, enabling rapid scaling during peak periods.

Full Operational Ownership
Coforge assumed 100% ownership of assigned work queues, improving transparency and reducing dependency on client teams.

Scalable Operating Model
Dynamic workforce and process model ensured optimal output during peak enrollment cycles.