Claims Intake Modrenization

The manual claim submission process at UnitedHealthcare presents challenges for members, including complexity, confusion, and technical difficulties. Users often struggle to navigate the process effectively, leading to errors, delays, and frustration. Improving the manual claim submission experience is crucial to enhancing member satisfaction and ensuring timely reimbursement for healthcare expenses.

Leveraging artificial intelligence (AI) to streamline the manual claim submission process and make it easier for members.

By incorporating AI technologies into the manual claim submission process, UnitedHealthcare can simplify the experience for members, reduce administrative burden, and improve efficiency and accuracy in processing claims.

Project Objectives: 

• Member needs: easier and faster claim submission flow. Faster processing and payout turnaround time 

• Business need: Improve NPS score for the claims intake flow and reduce calls related to claim submission

User research: 

• Worked with the research team to collect the data we had and conducted new research to further understand the problem space. 

Pain Point 

The claims intake forms are long and require members to fill in information that they do not understand, resulting in claim denial or a failure in submission. that leads to member's confusion and frustration. 

Opportunity 

Leveraging  AI (GPT4) technology to simplify intake-forms submissions will save time and hassle for members while improving form submission quality, reduce denial, failure in submission rates, and reduce call volume. 

Solution

The new flow allows members to take and/or upload pictures of receipts. AI streamlines the submission process in several ways: 

1. Natural Language Processing (NLP):

   - Implement NLP technology to interpret and extract information from unstructured claim documents, such as medical bills and receipts.

   - This would eliminate the need for members to manually enter data and streamline the submission process.

2. Intelligent Form Autofill:

   - Develop AI algorithms to automatically populate claim forms with relevant information extracted from supporting documents.

   - Members would only need to review and confirm the pre-filled information, reducing manual data entry errors and saving time.

3. Smart Document Upload and Verification:

   - Introduce AI-powered document recognition and verification capabilities to automatically identify and validate uploaded claim documents.

   - This would ensure that members submit the correct documents and reduce instances of rejected claims due to missing or incorrect information.

4. Personalized Guidance and Assistance:

   - Create AI-powered chatbots or virtual assistants to provide personalized guidance and assistance to members throughout the claim submission process.

   - Members could ask questions, receive real-time support, and get proactive notifications about the status of their claims.

5. Predictive Analytics for Claim Processing:

   - Utilize predictive analytics models to forecast claim processing times and likelihood of approval.

   - Members would receive estimated timelines for reimbursement and proactive alerts about any potential issues or delays.

6. Continuous Learning and Improvement:

   - Implement AI-driven analytics to analyze member interactions, feedback, and claim data to identify trends, patterns, and areas for improvement.

   - We could use this insights to continuously optimize the manual claim submission process and enhance the overall user experience.

By incorporating AI technologies into the manual claim submission process, we can simplify the experience for members, reduce administrative burden, and improve efficiency and accuracy in processing claims.