BTOES Insights Official
December 30, 2022

Cognizant's 2021 AWARD FINALIST CASE STUDY: Best Achievement in Operational Excellence to deliver Digital Transformation

Read this article about Cognizant Technology Solutions India, Finalist in the Best Achievement in Operational Excellence to deliver Digital Transformation, selected by the independent judging panel, for the 2021 Digital Transformation & Operational Excellence Industry Awards program.

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Digital Innovation in US Healthcare Claims_ Digital Transformation

Customer - A leading not-for-profit US East-Coast-based health plan, serving 3+ million members.

Business Problem: The client has a low Claim Auto adjudication rate of 59% (vs. benchmark of 80%) and Payment accuracy rate of 93% (vs. benchmark of 99%). This sub-optimal performance was resulting in contractual SLA misses, along with interest and service credits, provider dissatisfaction, and high call volumes in the contact center.

Root Cause: Configuration issues faced during migration from Legacy to a new platform.

Solutions Implemented

  • Analyzed and corrected configuration errors with a direct impact to Auto adjudication rate
  • Deployed 150 bots, processing 9% of new day & rework claims end to end using, UI Path - RPA solution
  • Applied SQL scripts to hold claims from 48 error prone categories for accurate claim payment
  • 838 employees trained & certified to build & use of digital assistants using UI Path

Awards CTA

Business Impact delivered

  • Savings of $30 M delivered across last 3 years
  • Around 440K Claims identified and $57M overturned with Interest savings of $2M
  • Improvement in AA rate to an avg of 87% with help of RPA BOTs & scripts
  • Reduction in Claims adjustments (Rework) from 12% to 9%
  • Provider Survey on CSAT improved from 89% to 96%
  • Achieved 100% compliance with SLA Targets on Financial, Procedural and Payment metrics
  • All BOTs built uploaded in “Bot Library” for easy of adoption by entire Healthcare BU at Cognizant
  • Same BOTs already replicated for new businesses

In Addition, the following levers were also implemented to improve the overall efficiency and customer experience -

1) Robotics Process Automation (RPA) using UI PATH

  • Identified claims that cannot be processed using systemic Auto Adjudication
  • Built a total of 150 BOTs processing claims day 1 & rework claims end to end using RPA solution from UI Path

2) Predictive Process Modelling (Random Forrest technique)

  • Analyzed data of claims paid late with Interest penalty
  • Derived the propensity of higher Interest penalty by claim types using analyzed historical data
  • Designed SQL scripts which would trigger the new platform to pend high interest propensity claims for manual adjudication.

3) Citizen Developer Program

  • Institutionalized a framework of training & certifying employees to build employee assisted BOTs
  • Completed Training & Certification of 214 employees to build such BOTs
  • 838 employees trained & certified to use such BOTs

4) HMS Eliza’s & Single user Interface for Contact Center & Automated Outbound calling

• Identified list of systems and applications used by contact center CSRs while troubleshooting Provider enquiries
• Worked with the Engineering teams to develop a Single User Interface (SUI) that takes feed from other (most)applications used by CSRs
• Designed & deployed Automated Outbound calling using HMS ELIZA for welcome calls of newly enrolled members

New Awards CTA

Replication & Reuse of Solutions

  • All BOTs built have been uploaded in “Bot Library” (KM portal) for easy replication
  • Solution with Predictive modeling of claim arrival patterns highlighting payment accuracy propensity showcased & shared across the enterprise
  • HMS Eliza User interface has been evaluated by other healthcare engagements at Cognizant DBO

Digital Transformation & Operational Excellence Industry Awards 2021


About the Awards

The Digital Transformation & Operational Excellence Awards have been established to showcase globally the most outstanding achievements through the application of Business Transformation, Digital Transformation, Operational Excellence & Innovation Excellence programs. Click here to view the Press Release.

The winners will be announced at the Awards Ceremony at The Digital Transformation & Operational Excellence World Awards (DTOES) on Wednesday, December 15th, 2021, from 6:30 PM at Renaissance Orlando at SeaWorld®.

The Business Transformation & Operational Excellence Awards are open to all organizations, both private and public sector, across the globe, which have implemented Business Transformation, Digital Transformation, Operational Excellence & Innovation Excellence programs to deliver outstanding business results.

The Awards will be held in conjunction with the Business Transformation & Operational Excellence World Summit, BTOES 2021 on December 15, 2021, at the Renaissance Orlando at SeaWorld®. Click to access the agenda, view the current speakers, and watch the highlights video from last year.



Highlight Video 


The issues in this article are just one of topic areas that are going to be discussed at the Business Transformation & Operational Excellence World Summit & Industry

BTOES is the industry’s biggest and best, senior-level, cross-industry gathering of Business Transformation & Operational Excellence industry leaders and senior executives.

With over 150 speakers, over 100 sessions, 12 Keynotes, 9 Track Themes, 5 parallel tracks, 60+ track sessions, 50 roundtable discussions, 20 Interactive Workshops, 6 Thought Leader Panels, 5 Leaders Boardrooms, 5 co-located events, the Industry Awards Program, Site Visits, 20+ hours of social networking including 2 gala cocktail parties, dinners, numerous group activities, this is the ultimate event to benchmark, network and drive Operational Excellence to the next level. 

Quick Links



BTOES Awards 

There is a strong focus on Cultural Transformation, Customer Delight, Sustaining an Operational Excellence program, Need for end-to-end Business Transformation, Keeping up with new technologies/impact of digitalization and Leadership Buy-in & Understanding. We dedicated two tracks to advanced technologies, such as AI, Machine Learning, RPA, Predictive Analytics, Blockchain, Cloud infrastructure etc.

The agenda is designed to encourage active meaningful conversations through all day enhanced networking and interaction opportunities, including

For more information please email

The Business Transformation & Operational Excellence Industry Awards

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