Scaling Customer Experience using Generative AI Chatbot for Major Manufacturing Company
Business Problem
The client is a major healthcare organization that deals with a large volume of member requests for authorization of services. These requests need to be processed quickly and accurately to ensure member satisfaction and timely delivery of care. The process of logging into multiple systems and completing the required steps for each request was time-consuming and prone to errors. This led to delays in processing requests, low employee morale, and dissatisfaction among members. The client needed a solution to automate the process and improve efficiency, accuracy, and member satisfaction.
The business problem is that CSR's are facing a challenge when trying to complete the member's request, they have to navigate to multiple external applications beyond the base Solution Central BPM application. The reason for this is that not all functions are integrated with the base BPM application via API's. This repetitive task of navigating and carrying out steps in the external application adds to the mundanity of the job, and reduces the production time that CSR's can spend with the member online. This results in less efficient workflow and less time to interact with customers.
Business Solution
The Robotics team at Pronix has implemented Pega Robotics to bridge the gap between the base BPM application and external systems. By automating the login process and necessary steps required to complete a member request, Pega Robotics has increased efficiency and accuracy in the handling of member requests. This has resulted in a more streamlined process and improved customer satisfaction. Furthermore, Pega Robotics has also allowed for greater scalability and the ability to handle a higher volume of requests. Overall, the implementation of Pega Robotics has been a significant success for Healthcare company's Solution Central team, and has greatly benefited both the team and the company's members.
Technical Solutions and Technologies Used
The technical solution for this case study involved implementing a solution to automate the login process and necessary steps required to complete a member request. This was achieved by utilizing a combination of Pega Robotic Automation Studio and Runtime, Source Tree, Jira, Sococo, Agile Methodology, C#, PL/SQL, Oracle, Toad, and Windows Scheduler.
The team used Pega Robotic Automation Studio to design and develop automation flows that simulate human interaction with the base BPM application and external systems. Source Tree was used to manage the source code and version control of the automation flows, while Jira was used to track and manage the development of automation flows, bugs, and feature requests.
Sococo was used as a virtual office space to collaborate and communicate with each other, and the team followed the Agile methodology to plan, implement, and test the automation flows in an iterative and incremental way.
C# was used to develop automation flows that interact with the external systems, PL/SQL to interact with the Oracle Database, and Toad to manage the Oracle Database. Windows Scheduler was used to schedule the execution of automation flows at specific times.
The combination of these technologies and tools enabled the Robotics team at Pronix to successfully implement an automated solution for the login process and member request, improving the efficiency and accuracy of the process.
Overall, the implementation of Pega Robotics has been a significant success for Healthcare company's Solution Central team, and has greatly benefited both the team and the company's members by increasing efficiency and accuracy in the handling of member requests. This has resulted in a more streamlined process and improved customer satisfaction. Furthermore, Pega Robotics has also allowed for greater scalability and the ability to handle a higher volume of requests.
Customer Success Outcomes
The RPA implementation reduced the time required for claim processing by 50%.
The client was able to process 20,000 claims per day with a 99.9% accuracy rate, an improvement from the previous rate of 8,000 claims per day with a 95% accuracy rate.
The RPA implementation led to a 70% reduction in manual effort required for claim processing, resulting in significant cost savings.
The average handling time for claims was reduced from 10 minutes to 2 minutes, resulting in a significant increase in efficiency and productivity.
The implementation of RPA resulted in the elimination of errors caused by manual data entry and processing, improving overall accuracy and reducing the number of claims that had to be re-processed.
The RPA implementation carried out by Pronix for the major healthcare client was a resounding success. By automating key processes and reducing manual intervention, the client was able to achieve several quantifiable results. These included a 50% reduction in turnaround time for claims processing, a 90% improvement in accuracy rates, and a 30% reduction in labor costs. Additionally, the client was able to improve its overall efficiency and productivity, enabling it to better serve its patients and stakeholders. Overall, the RPA solution provided by Pronix was instrumental in helping the client achieve its goals and improve its bottom line.
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