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AI-Driven Automation of Medical Cost Refund Processing for Insurance Companies

altkomsoftware.com

Insurance

Information technology

Challenges in Claims Processing Efficiency

Insurance companies face escalating claims processing costs due to rigid legacy systems requiring manual intervention for email-based refund requests. Current workflows lack flexibility for process optimization without extensive development, while manual data extraction from emails creates bottlenecks and potential errors in claim registration.

About the Client

Software development company specializing in insurance solutions with a focus on process automation and AI integration

Strategic Project Goals

Implement workflow engine for no-code process customization
Automate 80% of standard refund requests through AI capabilities
Reduce manual data entry requirements by 70%
Enable seamless integration with existing insurance core systems
Create unified processing pathway for both digital forms and email communications

System Capabilities

Interactive digital refund request form with automated confirmation
Configurable workflow engine with decision rule implementation
AI-powered email parsing for automatic form population
Backoffice adjuster application with case management dashboard
Integration layer for core insurance system synchronization

Technology Stack

Spring Boot / Java 17

Camunda workflow engine

AWS Bedrock

AWS Sagemaker

Altkom Insurance Suite

System Integrations

Existing insurance core systems
Email servers (IMAP/SMTP)
Customer communication platforms
Payment processing gateways

Operational Requirements

99.9% system availability
HIPAA-compliant data handling
Scalable architecture for 10,000+ daily transactions
Response time under 2 seconds for critical operations
Role-based access control with audit logging

Business Impact Projections

Implementation of this solution is expected to reduce claims processing costs by 40-60% through automation, decrease processing time from days to hours for standard cases, and enable 30% greater throughput capacity without additional staff. The flexible architecture allows for rapid adaptation to changing regulatory requirements while maintaining compliance with healthcare data protection standards.