Can AI and automation finally untangle the complex web of healthcare claims processing? In this podcast hosted by Cognizant Sr Product Director Chenny Solaiyappan, Simplify Healthcare SVP Daniel Knies unveils how their innovative suite is revolutionizing claims processing with AI and automation. He shares how their solutions can reduce claims processing time from 60 days to just 8 days, eliminate manual data entry, and bring real-time efficiency to insurance companies across different market segments.
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Show Notes
- Current medical claims processing can take up to 30 days, compared to real-time pharmacy claims
- FHIR standards are pushing healthcare towards more real-time, interoperable systems
- Claims One product translates complex benefit configurations across different insurance platforms
- AI can automate claims testing and configuration processes
- Benefits One helps manage benefit plan filing for Medicare, Medicaid, and commercial markets
- Provider One standardizes provider data management and credentialing
- Simplify Healthcare’s solutions reduce manual data entry by up to 90%
- Claims configuration can be reduced from 60 days to 8-10 days using their technology
- AI helps prevent “configuration bloat” in claims adjudication platforms
- The company uses agile methodologies to foster innovation
- Real-time claims processing is the future of healthcare technology
- Their products are line-of-business agnostic across insurance markets
- AI can help generate automated test suites for benefit plan changes
- Staying relevant in technology requires deep industry understanding
- Healthcare IT is complex, with multiple interconnected systems
- Their Experience One platform uses AI for customer service interactions
- Continuous feedback and R&D are critical for product development
- Technology can help reduce overall healthcare costs
- Interoperability is key to improving healthcare workflows
- AI and automation are transforming healthcare IT infrastructure
About the speaker
A seasoned and results-driven Healthcare IT professional with over 25 years of experience in the Payer space. As SVP of Claims1™ at Simplify Healthcare, expertise lies in architecting products that configure online transaction processing (OLTP) systems and drive automation in critical areas like benefits and provider data management. The goal is to leverage technology to revolutionize healthcare workflows and deliver solutions that empower organizations.
About the host
Chenny Solaiyappan is the Director of Product Management for Cognizant Trizetto's Government and Quality Solutions, and a founding member of the ClaimSphere suite of products, encompassing quality, HEDIS ®, CMS Stars, and clinical solutions. An accomplished Intrapreneur and Lean Startup Practitioner, he plays a pivotal role in shaping the overall product strategy and serves as the HL7 DaVinci Business Co-chair. With a notable track record, Chenny has provided consultancy to over 30 health plans across the nation, consistently raising Quality and Star ratings in Medicaid, Medicare, Federal Employees Health Plan, and Commercial health plan sectors, collectively supporting 30 million lives. His outstanding leadership and innovative contributions have earned him prestigious awards, including the 2023 Top 20 Global Product Manager Award by Products That Count, as well as the 2021 and 2019 Product of the Year awards by Cognizant Trizetto.