Healthcare & Life Sciences

70,000 Claims a Month, By Hand

Medical Device Manufacturer

Summary

Claims volume exposed a manual bottleneck. The choice was rules automation or controlled AI with review.

Moment

Around 70,000 claims per month were processed manually. Forms arrived typed, handwritten, and misaligned, and variation broke traditional automation.

Tension

Stay manual to protect compliance, or test generative AI in a disciplined, auditable way.

Risk

Over-automation could raise error rates and regulatory exposure. Moving too cautiously would lock in cycle time and cost.

Approach

We paired AI extraction with human review and confidence thresholds. Automation handled high-confidence cases and routed edge cases to reviewers with clear audit trails.

Outcome

The approach created a path to remove significant manual effort, accelerate reimbursement cycles, and improve accuracy while making the boundaries of AI use explicit.

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