Automating Payer Operations: How Mphasis Enhances Efficiency and Compliance

As the healthcare industry transitions to a value-based care model, payers face increasing pressure to modernize operations. Efficiency, accuracy, and regulatory compliance have become critical as organizations strive to control costs, improve outcomes, and deliver a better member experience. However, many payers remain burdened by legacy systems, manual workflows, and fragmented data. To stay competitive and compliant, modernization is no longer optional, it’s a strategic necessity.

Mphasis, a leader in digital transformation and next-gen IT solutions, offers a suite of advanced automation tools and AI-driven platforms that enable healthcare payers to optimize their operations, improve compliance, and elevate member satisfaction.

Challenges in Payer Operations

Despite the growing need for transformation, many payers are held back by systemic inefficiencies:

● Manual Workflows: Processes such as claims adjudication and enrollment are still heavily reliant on human input, resulting in bottlenecks and high error rates.

● Compliance Complexities: Staying aligned with constantly evolving healthcare regulations adds operational strain and increases the risk of non-compliance.

●Data Silos: Disconnected systems and fragmented datasets limit visibility across the organization, undermining coordinated decision-making and slowing service delivery.

Mphasis' Approach to Transforming Payer Operations

To address these issues, Mphasis integrates artificial intelligence (AI), robotic process automation (RPA), and proprietary platforms that modernize operations while ensuring scalability and compliance.

AI and RPA for Smarter Claims Adjudication

Mphasis leverages AI and RPA to automate repetitive, rules-based tasks in the claims lifecycle. This approach not only reduces processing time but also minimizes errors, driving consistency and regulatory adherence.

HyperGraf™: Unified Data Intelligence

HyperGraf™ is an omnichannel analytics platform that synthesizes structured and unstructured data from across the enterprise and external sources. It enables real-time insights into member behavior, fraud detection, and operational trends, empowering better decision-making.

DeepInsights™: Cognitive Document Processing

DeepInsights™ employs machine learning and natural language processing to extract and standardize data from forms, tables, and scanned images. This ensures accurate data capture, streamlined processing, and reliable downstream system integration, crucial for high-volume operations like claims intake.

NextSTEP™: Agile IT Service Transformation

NextSTEP™ unifies automation tools, delivery accelerators, and agile frameworks into a single platform that simplifies IT modernization. It enhances operational agility, reduces testing and development timelines, and speeds up the deployment of digital initiatives.

Javelina™: Intelligent Core Administrative Platform

Mphasis Javelina™ is a cloud-based core administration system tailored for healthcare payers. It provides an integrated platform for claims management, member enrollment, and provider administration. With embedded automation and compliance features, Javelina enables payers to manage high volumes with speed, precision, and agility.

Case Study: Cognitive Automation Improves Claims Productivity

A leading national third-party administrator (TPA) offering self-funded health plans faced growing challenges in processing a large volume of inbound claims. These claims arrived in multiple formats including HCFA, UB, and Dental, and required significant manual effort to extract and analyze the data. The result: delays, high operational costs, and inconsistent customer service.

Mphasis deployed its DeepInsights™ platform to automate the entire quote-to-claim process. The system ingested claims from varied formats, performed intelligent text and checkbox extraction, and converted unstructured information into structured, actionable data. Claims data was then integrated with internal systems using EDI 837 protocols.

The implementation of Mphasis solutions consistently delivers measurable performance improvements across operational and customer-facing metrics:

●50% Reduction in Turnaround Time: Faster processing through intelligent automation of document intake and data integration.

● 60% Increase in Productivity: Significantly higher throughput achieved through reduced manual effort and smarter resource utilization.

● High Accuracy in Data Processing: Use of AI and machine learning to minimize errors and ensure data consistency.

● Streamlined Claims Management: Automation enables real-time decision-making and structured data handling across diverse input formats.

● Improved Member Experience: Faster service delivery and fewer errors lead to increased member satisfaction and trust.

Mphasis empowers healthcare payers to modernize confidently and sustainably. With the right combination of intelligent automation, agile infrastructure, and deep industry expertise, the path to operational excellence is not only achievable, it’s already underway.

Summary

What are the benefits of automating payer operations?
Automation enhances operational efficiency, reduces errors, ensures regulatory compliance, and drives a better member experience.

How does Mphasis facilitate this transformation?
Mphasis employs AI-driven platforms like HyperGraf™, DeepInsights™, and Javelina™, combined with RPA and agile frameworks like NextSTEP™, to automate and optimize every layer of payer operations.

What outcomes can payers expect?
Payers can expect faster processing times, lower administrative costs, greater data accuracy, and enhanced member satisfaction—key differentiators in the evolving value-based care environment.