Summary
The client manages and tracks patient insurance claims using Smartsheet and an external insurance portal. Claim identification, validation and status updates were manual, producing delays and a growing backlog.
We automated claim filtering in Smartsheet, validation through the insurance portal, data extraction and status updates. The robot identifies eligible claims, extracts details, downloads Explanation of Benefits documents, captures supporting screenshots and updates everything back into Smartsheet. Processing time fell from 3 minutes per claim to under 1 minute, and the backlog was eliminated.
The client
The client operates in healthcare and handles a continuous flow of insurance claims submitted for patient treatments. Smartsheet is the primary tracking system for claim status and operational workflow. The claims operations team validates claim details, checks payment status from insurance portals, maintains documentation such as EOBs, and keeps Smartsheet accurate for reporting and audit.
The problem
Every claim required a person to move between two systems and document what they found.
- 01Log into Smartsheet and review all patient insurance claims
- 02Filter claims eligible for further processing
- 03Log into insurance portal websites and search for claim details
- 04Extract claim number, paid amount, patient name and payment recipient
- 05Download EOB documents and capture screenshots as evidence
- 06Update Smartsheet manually with the extracted details
What it was costing
- High manual effort on highly repetitive tasks
- Around 3 minutes of processing time per claim
- Growing claim backlogs as volume increased
- Risk of data entry error and missing documentation
- No scalability without adding headcount
Objectives
Goals
- Reduce manual effort in claim validation and updates
- Accelerate claim processing time
- Eliminate claim backlogs
- Improve data accuracy and consistency in Smartsheet
- Ensure complete documentation with EOB files and screenshots
- Enable scalable operations without additional resources
Success criteria
- Average processing time per claim
- Backlog reduction
- Data accuracy
What we built
The robot does the whole loop — decide which claims need work, go and find the answer, prove it, and write it back.
Eligibility filtering in Smartsheet
The robot logs in and identifies claims eligible for processing, flagging and queueing them for validation.
Insurance portal lookup
The robot signs into portal websites and searches for each claim's details.
Field extraction
Claim number, paid amount, patient name and payment recipient extracted per claim.
EOB and evidence capture
Explanation of Benefits documents downloaded and supporting screenshots captured for audit.
Automatic write-back
All extracted information updated back into Smartsheet without manual entry.
Delivery
Phased delivery — discovery through post-deployment support
- Process discovery and Smartsheet workflow analysis
- Portal interaction and data extraction design
- Bot development and testing
- Validation with claims operations
- User acceptance testing
- Production rollout and support
Challenges and how we handled them
Stakeholders
Results
| Measure | Before | After |
|---|---|---|
| Processing time per claim | ~3 minutes | Under 1 minute |
| Claim backlog | Growing | Cleared |
| EOB documentation | Manual download | Automatic, every claim |
| Audit evidence | Inconsistent | Screenshots captured per claim |
| Scaling | More headcount | More robot capacity |
Quantitative
- Average processing time reduced from 3 minutes to under 1 minute per claim
- Claim backlogs eliminated
- Complete documentation captured for every processed claim
- Scalable throughput without additional headcount
Qualitative
- The claims team focuses on exception handling rather than routine processing
- Real-time claim visibility in Smartsheet for reporting and audit
- Improved productivity and operational stability
Business value delivered
Real-time claim visibility
Smartsheet reflects actual payer status rather than whatever was last entered by hand.
Lower operational risk
Documentation is complete by default, so audit requests stop being a scramble.
Room to extend
The same approach now applies to additional claims and payer workflows.