MedAssist TPA Services

MedAssist was manually processing 1,800 insurance claims and 600 prior authorization requests per month across three insurer portals — each with a different UI, different data formats, and different submission rules. Average claim processing time was 22 minutes. A team of 11 was spending 80% of their time on data entry and portal navigation, with a 6.2% error rate triggering claim rejections and rework.

• 01Built a hybrid Power Automate solution within MedAssist's existing Microsoft 365 tenant — unattended bots for standard claims, attended assist mode for complex or disputed cases
• 02Developed three separate bot workflows — one per insurer portal — each handling login, data extraction from the internal TPA system, field mapping, submission, and confirmation logging
• 03Deployed Terraform-managed Azure infrastructure with the bot runner in a private subnet, credentials in Azure Key Vault, and all bot actions logged to a centralized audit table
• 04Wired Azure Monitor alerts to PagerDuty with severity routing — P1 (bot down), P2 (queue breach), P3 (elevated exception rate)
• 05Integrated prior authorization workflow: bot submits requests automatically and polls for insurer response, escalating to human queue only on denial or additional-information requests

• 87% straight-through processing rate — 1,566 of 1,800 monthly claims handled end-to-end without human intervention
• Processing time reduced from 22 minutes to 3.5 minutes per claim — a 6.3x throughput improvement with the same headcount
• Annual savings of Rs. 38 lakh in processing labour — the team of 11 now handles 3x the claim volume with 4 staff redeployed to client relationship management
• Claim error rate dropped from 6.2% to 0.3% — rejection-driven rework eliminated
• Prior authorization turnaround: from 2–3 days to under 4 hours for standard requests