The Next Applied
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Driving 50% Faster Auto Adjudication with Mphasis Javelina®

THE CLIENT

 

One of the industry leaders in health risk management and third-party administration of self-funded policies.


BUSINESS CHALLENGE

The client’s existing claims process was high volume, manual, and resource intensive, resulting in slow turnaround times, errors, high costs, and reduced productivity. They aimed to improve data collection, claims adjudication, and average handling time (AHT) to streamline processes and boost efficiency, accuracy, and user satisfaction.

THE SOLUTION

 

Mphasis partnered with the client to define and execute their transformational journey in claims processing. Our solution approach included:


  • Implementing the Mphasis Javelina® Core Adjudication System to modernize and streamline claims operations.
  • Applying Design Thinking to analyze processes and identify automation opportunities across 80% of claims.
  • Automating two key claim types (Accidental and Authorization), achieving 70% automation, fewer errors, and significantly faster turnaround times (TAT).
  • Developing proof of concept (POC) and RPA infrastructure to support ongoing automation and future use cases.

BUSINESS BENEFITS

The new adjudication platform enabled the client to:


Achieve 50%+ improvement in auto-adjudication within four weeks, with 30–35% faster claim processing.

Improve accuracy to 99.5% in financial and payment processes, reducing errors significantly.

Achieve projected cost savings of 40% over three years through automation and efficiency gains.

Enhance claims analytics and straight-through processing, driving better decision-making.

Free resources to focus on high-value activities, improving user satisfaction and patient outcomes.