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Whitepaper: Effective Claims Operations through Scaled Digital Adoption

We help integrate business with IT to get the maximum value possible from digital

An Everest Group whitepaper brought to you by Legato Health Technologies

✓ Downtime
✓ Upfront investment
✓ Training costs
✓ Data loss

Are these factors stopping you from taking the digital plunge in claims management processes?

Do you want to optimize your claims management processes? Do you know digitalization can improve auto-adjudication rates and increase cost savings?

Simple answer is – claims operations can be made more effective with scaled digital adoption.

On an average, a payer spends 85-90% of its revenue on claims payments. Apart from financially straining the payers, this inefficiency also leads to an unpleasant experience for members and providers. An optimized claim management process involves digital adoption, if not wholly, then at least in parts of the claims processes. Massive cost savings can be achieved by scaled digital adoption. A move from industry-standard digitalization to best-in-class digital adoption can help you achieve an overall 25-27% savings.


  • The paper focuses on the inefficiencies in the current claim management processes.
  • It recommends introducing artificial intelligence(AI)/ machine learning (ML) techniques to the existing layer of robotic process automation (RPA) to increase auto-adjudication rate and support claims adjudicators in decision making.
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  • Scaled digitalization can help reduce costs and deliver better member and provider experiences.
  • The collaboration between business and IT teams works best for effective digitalization.
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Find out how scaled digitalization is the key to making your claims management processes cost-efficient.
Download Whitepaper