PLAN TYPE
Commercial
PLAN SIZE
~18M
GEOGRAPHY
National
200K+
Documents processed monthly
98%
Appeals routing accuracy
96%
Field-level extraction accuracy
14%
Productivity improvement
Issue
A health plan managing a high volume of appeals and grievances relied on employees to manually review unstructured correspondence, extract key information, and determine where each case belonged before processing could begin.
Teams had to distinguish standard from expedited appeals and route each case to the correct workflow. When a case went to the wrong team, additional handoffs and auto-forwards slowed processing and put added pressure on service-level agreement (SLA) commitments.
The health plan needed a more dependable intake process — one that could identify each case, capture the information needed for action, and route it correctly from the start. Reducing manual triage would help minimize routing errors, speed case handling, and support more consistent SLA performance as volumes increased.
Action
The health plan partnered with Sagility to streamline intake and reduce the manual effort involved in triaging appeals and grievances. Sagility implemented their automated document processing solution that uses optical character recognition (OCR) and natural language processing (NLP) to read unstructured correspondence, extract key information, and prepare cases for routing.
The AI-powered solution identifies document types, distinguishes standard from expedited appeals, and applies configurable rules and validation checks before directing each case to the appropriate workflow. Sagility also integrated the extracted data with the health plan’s existing routing processes so teams could begin work with the information they needed already captured.
This created a more consistent path from incoming correspondence to case handling, reducing unnecessary handoffs and helping appeals move through the process more efficiently.
Impact
Sagility’s automated document processing solution now handles more than 200,000 documents each month, streamlining appeals and grievances intake and routing. More accurate classification and routing reduced unnecessary handoffs, particularly for expedited appeals, helping teams process cases more efficiently.
Results included:
- 98% routing accuracy
- 96% field-level extraction accuracy
- 100% overall quality
- 14% productivity improvement
- Fewer auto-forwards and routing errors in expedited appeals processing
With less manual sorting and forwarding, the health plan improved productivity and supported SLA commitments as volumes scaled. Teams received cases with key information already captured and routed to the appropriate workflow, allowing employees to spend more time on cases requiring greater attention instead of correcting avoidable intake and routing issues.
