The challenge
The Affordable Care Act provides health insurance to over 30 million Americans who might otherwise not qualify for employer-sponsored insurance. When the COVID-19 pandemic struck and many Americans lost work, there was a surge of applications from those seeking coverage. Citizens seeking to determine their eligibility using the Federal Health Insurance Exchanges operated by the Center for Medicare and Medicaid Services (CMS) were able to receive rapid and accurate information about the benefits they were entitled to under the law with Serco’s assistance.
Our solution
Since ACA’s launch, Serco has provided the backend processing support that has enabled millions of Americans to obtain health insurance, many for the first time. Serco has collaborated with CMS to introduce intelligent automation across the value chain. Elements include:
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Intelligent document capture and natural language processing to extract and verify critical data to verify identity and eligibility.
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Robotic process automation (RPA) to automate repetitive tasks and eliminate the potential for error.
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Dynamic work assignment that automates the sequence of tasks and escalations so that team members can collaborate efficiently.
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Automated decision support provides the knowledge worker with all relevant data for that case and incorporates thousands of business rules to enable accurate, rapid determinations.
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AI-based identity resolution to resolve discrepancies in names and identifying details and ensure program integrity.
Outcomes that matter
Using intelligent automation, Serco has enabled CMS to dramatically scale user volumes while increasing the speed and quality of eligibility determinations. As a result, millions more Americans have been able to qualify for subsidized health insurance during the pandemic so that families can get the care they need.