Member onboarding modernization with Gen AI powered Benefit Booklet & SBC Creation for One of the Largest U.S. Health Insurers

Challenges.

The insurer faced multiple challenges across processes, technology, and people:

• Process Challenges
  • Highly manual Benefit Booklet & Summary of Benefits Coverage (SBC) documents creation
  • High Turn-Around Time (TAT) and Average Handle Time (AHT)
  • Lack of standardization across Lines of Business (LOBs)
  • High defect rates leading to rework and member dissatisfaction
• Technology Challenges
  • Non-standard IT processes lacking application integration
  • No automation or sophisticated matching rules
  • Over-reliance on manual processes
• People Challenges
  • Heavy reliance on experienced staff
  • Insufficient workforce causing high TAT
  • Lengthy training periods and steep learning curves

Solution.

Coforge implemented a structured approach, combining process improvements, technology advancements, and workforce optimization to drive efficiency.

• Process Enhancements
  • Complete ownership of assigned work queues
  • End-to-end inventory visibility via a flexible workflow platform
  • Defined Quality Framework with robust transaction monitoring
  • Weekly Governance Plan & Monthly Reviews to track improvements
  • FIFO workflow to align with business priorities
• Technology Interventions
  • Leveraged Coforge’s GenAI solution for intelligent automation
  • Operations Excellence powered by GenAI engine to extract and process data with near 100% accuracy
  • Seamless integration with downstream systems for improved efficiency
• People Optimization
  • Refined Job Descriptions (JDs) to recruit highly skilled professionals
  • Established a Knowledge Bank, Checklists, and Process Maps for efficiency
  • Improved training mechanisms to shorten learning curves

The Impact.

Coforge’s solution delivered transformational benefits

• 75%+ reduction in benefit booklets & SBC processing time
• Zero backlog, all overdue items resolved
• 100% accuracy, minimizing rework
• Faster Turn-Around-Time (TAT)
• Effectiveness & Seamless integration with downstream systems
• Significant reduction in workload dependency on client teams
• Enhanced inter-departmental collaboration
• Flexible operating model, ensuring peak efficiency during high-demand periods

Coforge successfully transformed Benefit Booklet and SBC creation process through AI-led automation and process standardization, driving higher accuracy, greater operational efficiency, faster processing, and improved member satisfaction.