When Paperwork Slows the Pulse
For one of the US’s leading healthcare administration companies specializing in workers’ compensation and casualty insurance, the problem wasn’t intent; it was inundation. Each claim arrived with a flood of discharge summaries, prescriptions, X-rays and physician notes.
A single patient file could mean 30 to 160+ documents spanning multiple visits, often formatted differently across providers. Automation models struggled to keep up. As a result, claims adjudicators spent five to seven days manually reviewing PDFs and scanned records.
The human cost was mounting: fatigue, overlooked details, rework and SLA breaches. In a business where reimbursement speed drives trust, slow adjudication became an operational choke point. When every case demands a week to verify, efficiency isn’t a luxury; it’s survival.
From Templates to Thinking Machines
To solve this, Persistent partnered with the client to co-create an Agentic AI-powered Intelligent Document Processing (IDP) platform that not only reads documents but also understands them.
Unlike template-bound OCR systems, this Generative AI (GenAI) model was context-aware: capable of interpreting meaning, identifying relationships and summarizing insights with human-like precision. The architecture combined four intelligent layers:
- Entity Extraction: Capturing demographics, ICD/CPT codes and treatment details automatically
- Contextual Summarization: Condensing medical notes and creating longitudinal progress summaries
- Timeline Assembly: Sequencing records into a coherent patient journey to reveal trends and anomalies
- Accelerated Deployment: Powered by Persistent’s DocIntel accelerator, an agentic framework enabling speed, accuracy and scalability from day one
Each claim became more than a static record; it evolved into an interpretable dataset, ready to drive informed decisions.
Thinking Like an Adjudicator, at Machine Speed
The new system mirrored how claims professionals reasoned, only faster and without fatigue. It classified document types based on content, extracted comorbidities and treatments with 60% greater accuracy and assembled a chronological story of recovery.
Instead of sifting through hundreds of pages, adjudicators now receive a structured summary in under ten minutes, ready for validation and approval. Each review cycle improved the system’s intelligence, feeding back learning to achieve even higher accuracy.
Measured Impact, Meaningful Change
The transformation not only streamlined processes but also reshaped them. The results spoke in both metrics and momentum:
- 95% Reduction in Cycle Time: Reviews dropped from five to seven days to under 10 minutes
- 70%+ Productivity Gain: Teams redirected time toward complex, high-value claims
- 60%+ Accuracy Boost: Context-aware extraction reduced oversight and improvedompliance
- 40% Higher Throughput: Faster reimbursements strengthened provider relationships
- Improved Decision Quality: Timeline-based summaries enhanced fairness and auditability
The shift also minimized follow-up loops and re-submissions, reinforcing SLA performance across provider networks.
According to McKinsey, GenAI could unlock up to $110 billion annually across healthcare and life sciences by accelerating data interpretation and decision-making. The client is already realizing that value today.
Scaling Beyond Claims
The success does not end with claims review. The same agentic framework is now scaling across the healthcare solution provider’s broader enterprise stack:
- Integrating directly with enterprise claims platforms for end-to-end adjudication
- Expanding into new insurance lines such as general health and casualty
- Extending to document-intensive workflows in compliance, legal and financial
Industry momentum underscores this direction. Deloitte reports that 74% of insurers are prioritizing AI-driven document automation to improve claims accuracy and turnaround.
Why Persistent
The impact was powered by Persistent’s deep engineering and domain insight:
- Agentic Frameworks at Scale: Proven through DocIntel, a GenAI document intelligence accelerator
- AI-First Engineering Discipline: Pipelines built for reliability, security and control
- Cross-Domain Expertise: BFSI and healthcare knowledge ensuring compliance and privacy
- Cloud-Agnostic Architecture: Modular, flexible and ready for new document types
- Outcome Orientation: Measurable business impact from day one
Persistent’s close co-innovation with the client’s domain SMEs ensured seamless adoption, making technology an ally rather than a hurdle for adjudicators.
From Overload to Orchestration
By blending Agentic AI reasoning with GenAI comprehension, Persistent helped the healthcare management enterprise reimagine adjudication as an intelligent, adaptive ecosystem. From weeks of review to minutes of insight, from complexity to confidence, the engagement redefined what precision and speed can mean in claims operations.
Reimagine your claims workflow. Transform documents into decisions. Talk with Persistent.
