Executive Summary

  • Client: a healthcare insurance provider in USA
  • Challenge: Manual claims processing led to delays, errors, and customer dissatisfaction.
  • Solution: A custom React Native contact center app with AI-driven automation and cloud integration.
  • Results:
    • 60% faster claims processing time.
    • 45% reduction in manual errors.
    • 30% improvement in customer satisfaction scores.

“American Chase transformed our claims workflow from a bottleneck to a competitive advantage.”

 – Representative of Healthcare Insurance provider

Client Background

Who They Are

The healthcare company serves over 500,000 policyholders across the U.S., specializing in affordable healthcare plans. Their mission is to simplify insurance for families and businesses.

Pre-Challenge State

  • Relied on legacy systems and manual data entry for claims processing.
  • Agents struggled with outdated tools, leading to backlogs and frustrated customers.

“We were drowning in paperwork, and our customers were losing patience.“

 – COO of Healthcare Insurance provider

The Challenge

Pain Points

  1. Manual Data Entry: Claims took 10+ days to process due to repetitive paperwork.
  2. Error-Prone Workflows: 25% of claims required rework due to inaccuracies.
  3. Scalability Issues: Legacy systems couldn’t handle seasonal claim spikes.

Business Impact

  • Rising customer complaints and attrition.
  • High operational costs from inefficient workflows.

Client Goals

  • Automate claims processing.
  • Empower agents with real-time tools.
  • Scale operations to meet growing demand.

The Solution

Approach

  • Developed a cross-platform React Native app for contact center agents, enabling seamless iOS/Android use.
  • Leveraged Agile methodology to align with Client’s evolving needs..

Technologies Used

  • Frontend: React Native for a responsive, intuitive UI.
  • Backend: AWS cloud infrastructure for scalability.
  • AI/ML: Automated data extraction from scanned documents.
  • Security: HIPAA-compliant encryption for sensitive data.

Key Features

  1. Automated Claim Submission: AI scanned and categorized documents, reducing manual input.
  2. Real-Time Dashboard: Agents tracked claim status, customer history, and KPIs.
  3. Secure Document Upload: Policyholders submitted claims via a branded portal.

Implementation Process

Timeline

  • Phase 1 (Discovery): 2 weeks of workflow analysis and stakeholder interviews.
  • Phase 2 (Development): 3-month sprint for app design and integration with client’s CRM.
  • Phase 3 (Testing): Rigorous QA and user acceptance testing (UAT).
  • Phase 4 (Deployment): Rolled out to 200+ agents in 2 weeks.

Team Structure

  • Project managers, React Native developers, AI specialists, and QA engineers.

Overcoming Hurdles

  • Integrated the app with Client’s legacy systems using custom APIs.
  • Trained agents via interactive workshops to ensure smooth adoption.

Results and Impact

Quantitative Metrics

60%

Faster Processing

Claims resolved in 4 days vs. 10+ days.

45%

Fewer Errors

AI reduced manual data entry mistakes.

30%

Operational Cost Savings

Reduced rework and staffing needs.

Qualitative Benefits

  • 📈 Improved customer satisfaction with real-time claim updates.
  • 🚀 Agents reported higher productivity and job satisfaction.

“The app cut our processing time in half and gave our team superpowers.“

  – CEO