Zoho RPA for Healthcare | Automating Insurance Claims Reconciliation

Client Overview

A major healthcare provider with 20+ super specialty hospitals, with each hospital handling 500+ records weekly, faced a mounting challenge in reconciling insurance claims settlements. Given the complexity of multi-stage claim settlements and discrepancies between billed and settled amounts, the manual reconciliation process was proving to be inefficient, error-prone, and time-consuming for their finance team.

The Challenges

Managing healthcare billing across multiple branches posed significant challenges for the client. Their manual processes left room for error, delays, and inefficiencies that strained financial accuracy and operational performance.

Oracle ERP required manual reconciliation of insurance settlements.

Multiple hospital branches generated complex billing transactions daily.

Claims varied across first, further, or rejected settlements.

Accounting team manually matched data with insurer reports.

High volume slowed operations and increased processing delays.

Risk of errors threatened accuracy and financial transparency.

This complex billing environment created the need for a streamlined approach, opening the path for us to introduce a tailored solution that reduced manual effort and improved operational efficiency.

The Solution: Zoho RPA Implementation

To streamline claims reconciliation, Codelattice implemented Zoho RPA to automate the entire process. The system eliminated manual bottlenecks, ensured accurate matching between ERP and insurance data, and enabled timely reporting while maintaining compliance and transparency.

Rapid Backlog Clearance Within Month

RPA bots cleared pending claims efficiently and systematically.

This accelerated reconciliation timelines, reducing operational delays and ensuring financial processes remained on track for the insurance and hospital teams.

Proactive Patient Refund Processing

Automation processed patient refunds in advance of standard cycles.

This improved patient satisfaction and reduced administrative intervention, ensuring timely reimbursements and enhancing trust in hospital operations.

Continuous Insurance Performance Monitoring

Bots tracked insurance department performance daily or weekly.

Real-time monitoring ensured accountability, highlighted bottlenecks, and allowed management to proactively address inefficiencies across multiple hospital branches.

Daily Insurance Portal Data Extraction

RPA logged into portals to pull updated settlement information.

Automation guaranteed consistent data capture from multiple insurers, removing manual effort and reducing errors in information retrieval.

Claims Classification by Settlement Status

All claims were categorized as fully, partially, or rejected.

The system also identified settlement stages, allowing precise tracking and reporting for accurate financial management.

ERP Data Comparison and Discrepancy Highlighting

Extracted portal data was matched against Oracle ERP entries automatically.

Discrepancies between billed and settled amounts were flagged for review, ensuring transparency and eliminating reconciliation errors.

Comprehensive Reconciliation Report Generation

Automation produced detailed reports including billed amount, settled value, and pending balance.

Reports also captured settlement stages and rejection reasons, giving finance teams a full overview for decision-making.

Reverse Traceability to Original ERP Bills

The system traced each claim back to its originating ERP entry.

This ensured full transparency, accountability, and accuracy across all transactions for audit and compliance purposes.

Enhanced Accuracy and Operational Efficiency

Automation removed repetitive manual tasks and reduced human errors.

Finance teams could focus on higher-value activities, improving overall productivity and ensuring timely, error-free settlements.

This RPA-driven solution provided a highly accurate, transparent, and scalable claims reconciliation process. It laid the foundation for measurable improvements in efficiency, accountability, and financial accuracy, paving the way for tangible results.

The Results

The implementation of Zoho RPA transformed the claims reconciliation process for the healthcare provider by:

70% Manual Workload Reduction

Higher Accuracy in Data Matching

Real-Time Automated Reporting Insights

Rejection Pattern Identification Enabled

Stronger Security, Reduced Leakage

Faster Settlements, Improved Cash Flow

Conclusion

The successful implementation of Zoho RPA highlights how automation can revolutionize complex healthcare finance operations. By eliminating manual bottlenecks and reducing errors, the solution delivered measurable results including greater efficiency, improved accuracy, and strengthened financial controls across multiple hospital branches. This transformation enabled the client’s finance team to focus on strategic tasks while ensuring faster, more transparent settlement management.

With scalability built into the system, the client is now equipped to handle growing transaction volumes without compromising accuracy or compliance. This case study demonstrates how Codelattice leverages proven expertise and trusted technology partners to deliver future-ready automation solutions for healthcare organizations.

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Streamlining Insurance Claims Reconciliation with Zoho RPA for a Leading Healthcare Company