OpenConnect: Simplifying Medical Claims Processing

Mark Dailey, CEO
Robotic process automation (RPA) is a catalyst for business process transformation and innovation, as it is geared towards automating a variety of manual business and computing processes. RPA also presents multifarious opportunities for healthcare insurers to save costs and streamline business processes. With technology becoming more sophisticated, healthcare payers, both small and large, are under pressure to reduce the total cost of claims administration—including claims adjudication and increases in the speed and accuracy of claims settlement. Alongside the current transformation in healthcare, RPA is also shifting from a desktop-based to a server-based platform.

This is where OpenConnect steps in, to offer cutting-edge solutions and services for medical claims processing. The company offers a server-based automation solution that allows software robots to access mainframe data directly from the network, instead of using a desktop-based emulator. “We specialize in automating complicated medical claims processing,” says Kevin Culliton, OpenConnect’s VP of Product Management. “Our healthcare customers have seen their claims auto-adjudication rate improve by as much as 15 percent, saving millions of dollars.”

OpenConnect’s process automation solution, AutoiQ, is designed to automate business processes, improving processing speed and quality while reducing the count of full-time equivalents (FTEs). Using the same application interfaces and processes that are typically executed by a human, AutoiQ can natively access any Web-based, desktop-based, or mainframe application, including any application that provides an application program interface (API). Instead of accessing mainframe applications through a desktop-based emulator, AutoiQconnects to the mainframe from the server where AutoiQ is installed and interacts with raw 3270 data, thereby reducing data errors (particularly since AutoiQ, unlike an emulator, retains all data) and inefficiencies. “It is designed to automate routine tasks and workflows, improving user efficiency,” states Culliton. “OpenConnect automation solutions are currently processing over 50 million claims per year, and no downtime has yet been associated with the products.”

Another OpenConnect product, WorkiQ, captures end users’ activity directly from user desktops.

OpenConnect automation solutions are currently processing over 50 million claims per year, and no downtime has yet been associated with the products

Through WorkiQ, the company provides analytics and allows managers to improve their work rate in real-time by automatically identifying each employee’s actual productive time and capability. The combination of WorkiQ and AutoiQ helps managers fine-tune their operations by automating manually executed processes.

In addition, OpenConnect delivers best-of-breed mainframe integration solutions like ConnectiQ, a platform that allows customers to convert “green screens” into web services, so they can be integrated with any modern application. Also, the Web-enabled terminal emulation solution, WebConnect, allows users to access legacy mainframe, midrange, and UNIX/Linux environments.

In one instance, OpenConnect helped a large healthcare insurance company automate its manual claims processing. Previously, the client evaluated other RPA products which interacted with a desktop-based mainframe emulator. “They were unable to handle the complexity and scalability required to automate the processes,” says Culliton. By contrast, OpenConnect’s solution helped the customer efficiently reduce business costs and handle the problem of claims processing within a short span of time.

Forging ahead, OpenConnect is working to add “intelligent analysis” to its automation and analytics products. This will include cognitive capabilities that allow systems to use unstructured data and learn from human feedback. “Intelligent analysis will provide answers to questions, instead of data and charts that require users to perform manual analysis,” concludes Culliton.



Mark Dailey, CEO and Kevin Culliton, VP of Product Management

Allows users to access mainframe data directly to perform back-end orchestration and desktop automation