Healthcare claims processing is traditionally slow, manual, and error-prone. With hundreds of documents and rules involved, delays are common and costly. That’s why more providers are turning to automation. At Flobotics, we deploy RPA-powered Automation Agents that integrate with your systems to streamline the entire claims lifecycle, from intake to reimbursement.

Manual claims processing is resource-heavy. Billing teams often spend hours extracting data from patient records, entering it into multiple systems, validating coverage, attaching documentation, and finally submitting the claim. Each step introduces potential errors, delays, and compliance risks.

With automation, the entire workflow can be reimagined:

RPA bots mimic human actions, such as logging into systems, copying data, navigating interfaces, and executing rule-based tasks. In claims processing, RPA can:

• Extract patient data from intake forms or EMRs
• Validate insurance details against payer portals
• Populate claim forms with structured data
• Submit claims via web portals or APIs
• Monitor claim status and log activity for audit trails

These bots operate 24/7, don’t require breaks, and complete tasks in parallel, significantly increasing throughput without expanding headcount.

While RPA handles structured, repetitive tasks, Agentic AI adds intelligence, adaptability, and autonomy. Built on large language models and cognitive frameworks, Agentic AI can:

• Interpret unstructured data like scanned documents or handwritten notes using OCR and NLP
• Identify missing documentation and autonomously request it from EHRs or staff
• Adapt to changing payer rules or claim formats without being reprogrammed
• Communicate with stakeholders (e.g., follow up with a patient for info or clarify insurance details via email or chatbot)
• Make decisions, like flagging high-risk claims for human review or prioritizing urgent reimbursements

Agentic AI agents act as proactive team members, not just rule-following bots.

The most powerful approach blends both technologies. Here’s how a combined workflow might look:

1. Patient data intake: AI reads unstructured forms and translates them into structured data.
2. Eligibility check: RPA bots verify insurance coverage in real time.
3. Claim prep: RPA fills forms; AI ensures documentation is complete and codes are accurate.
4. Submission: RPA submits the claim and logs the transaction.
5. Follow-up: AI monitors claim status, handles exceptions, and triggers actions (e.g. resubmission, outreach).
6. Insights & learning: Agentic AI analyzes outcomes and adapts logic to reduce future denials.

This hybrid system isn’t just faster — it’s smarter. It reduces rework, ensures compliance, and frees up human staff for value-added tasks like handling appeals or optimizing billing st

Pain Treatment Centers of America (PTCoA) automated their claims process. With a $ 19,000 investment, they freed up the equivalent of four full-time employees and achieved an ROI in just 23 days. The bots now submit claims 24/7, reducing denials and improving overall efficiency. In their first year alone, they projected $180,000 in savings.

Before implementing automation, ensure your current process is efficient. Map it out, eliminate unnecessary steps, and align your team. Select a pilot project, such as claims intake or validation, and begin with a small-scale approach. Use flexible, HIPAA-compliant RPA tools (like UiPath or Automation Anywhere) that integrate well with your tech stack and scale as needed.

1. Identify Automation Targets: Look for repetitive, rule-based tasks like eligibility checks or data entry.
2. Prioritize High-Impact Areas: Focus on tasks with large time savings or high error rates.
3. Document and Build: Define workflows step-by-step so bots can replicate them accurately.
4. Test, Launch, Scale: Begin with a small implementation, validate the results, and then gradually expand automation.

Automated claims processing isn’t just a trend – it’s a competitive necessity. It speeds up cash flow, reduces denials, and lets your team focus on care. Flobotics’ Automation Agents combine RPA, AI, and document understanding to deliver fast ROI and lasting impact.

Whether you’re a small clinic or a large hospital, the tools and expertise are here. Start small, scale smart, and let automation handle the grunt work. Flobotics is ready to help you make that leap.