Founded in 2002, this US-based insurance provides managed care services for government-sponsored health care programs, focusing on Medicaid and Medicare. They also offer health plans for families, children, and the aged, blind, and disabled, as well as prescription drug plans.
Industry: Health Insurnace
Annual Revenue: $20 Billion
Customer Since: 2016
“We kept hearing that we needed to be using a PDD, which is only available as a word document. Everyone kept saying it was faster, but we were hesitant about using paper-based documentation. In the end, we said we’ll do it and see if it’s faster, but we’ll do it in Blueprint.”
- IT Manager
The insurance provider has one clear purpose: to help people live healthier lives by providing access to high-quality healthcare, innovative programs, and a wide range of health solutions that help families and individuals get well, stay well and be well.
To achieve these goals, the insurance provider wanted its workforce as closely aligned with its customers’ needs as possible, and to improve their ability to meet these needs by automating key processes within a number of business areas such as claims, IT operations, customer service, and their pharmacy benefits services.
Prior to engaging with Blueprint, the insurance provider had already experienced significant success with process automation. The team in their pharmacy benefits area typically audits at least 5% of the claims submitted the previous day to ensure what was paid against a customer’s benefits and membership was correct. With changes happening in the marketplace, the insurance provider saw a rapid influx in demand in this area. With an additional 2 million members being added from a merger, they would have needed to bring in an additional 6 resources to manage the volume. Instead, they automated this process – allowing them to keep their current staff size and go from 5% of claims audited to almost 100%. In addition, the automation was developed to look back at previous claims made under other organizations and ensure the customer could still get their same medications from the insurance provider – something they could now do with a bot that people couldn’t even do before.
“Once we received the additional 2 million members from a merger, in order to keep auditing 5% of the previous day’s pharmacy benefits claims we would have had to hire an additional 6 full-time employees. Instead, we decided to automate the process and didn’t have to bring on anybody new. We could keep our current staff size and go from a 5% audit to almost a 100% audit of the previous day’s claims.”
- IT Manager
With RPA already proving its value and ROI, the insurance provider looked to apply additional areas and functions as well. However, after being mandated to move from their current process of using BRD/FSD documents to PDD documents to define automated processes, which is only available as a word document, they quickly realized that they needed a more scalable way to translate business process requirements into technical requirements for their RPA development teams.
Before they engaged with Blueprint, they tried to create the PDD themselves, but they struggled to get process screenshots in line with steps. The screenshots, which were critical for improving developer understanding of what was required, would show up as attachments at the end which was not useful because the developers still would have to flip back and forth through the documents. In addition, using a paper document is just a pain overall due to moving back and forth between different versions. It was challenging for them to know if they were using the right version, and if someone made a change to the document it was impossible to know or track.
After doing a comparison of all the options available for defining their process requirements, they felt Blueprint was the only one that would provide the type of visibility and tracking they needed for approvals, change requests, line-level detailed changes, and governance over their digital workforce. The insurance provider began working with Blueprint to create a digitized version of their process design document, which would add significant value above and beyond what a paper-based version of this document could provide.
By modeling their processes digitally, as well as other critical business information such as regulatory requirements, non-functionals, and customer journeys, they are able to better capture exactly what’s needed from the business as well as what their development teams need to build to deliver on this. They’re also able to define specific fields that capture the ROI of their automation and the systems attached to each step of the process, which has improved alignment across these teams.
By doing the work in Blueprint instead of a paper document, they’re also now able to leverage reuse capabilities, which will save a significant amount of time and effort as they expand their automation programs. And because all of this information is captured and stored within a centralized repository, they no longer have to worry about document versioning and chasing down the most current iteration. By listing all regulatory and non-functional requirements and business rules in Blueprint, they can easily relate these to multiple automations being developed to ensure consistency with quality and compliance across their digital workforce.
Lastly, because they can add in-line documentation and screenshots related to processes within Blueprint, when it comes time to share a paper version of a PDD with other teams they can simply click a button to generate the document and all of the screenshots will appear in-line with the requirements instead of as an appendix – making it significantly easier for developers to understand exactly what’s required.
To date, using Blueprint has improved the speed at which the insurance provider can design and define processes for automation, and reduced the amount of back and forth when defining requirements. Although development has yet to begin on the processes the insurance provider has designed for automation within Blueprint, they anticipate that using Blueprint to define and deliver the PDD documentation digitally will increase the speed in which their RPA developers can turn automated processes around. They are also anticipating a drop in the number of change requests that come up during development and testing because they’ve been able to account for constraints and exceptions upfront, and there are less opportunities for requirements to be missed.
Looking into the future, the insurance provider does not want to stop with simply building digital PDDs in Blueprint. By leveraging Blueprint’s integration capabilities with UiPath, they would be able to seamlessly sync their processes directly from Blueprint into UiPath as ‘skeleton processes’ – eliminating the need to export a paper copy of the PDD from Blueprint to hand over to their development teams.
They’ve also spent a lot of time on their governance and library of reusable pieces, developing 12-20 bots within their first year with only 5 people. Moving forward, they’re looking to focus on not only leveraging Blueprint to develop more bots but are also interested in getting into machine learning and AI.