AIBPO
Use Cases

AI Workflows ThatTransform Operations

Discover how AIBPO's AI-native agents automate complex back-office processes across healthcare and insurance, delivering measurable results from day one.

Healthcare
Pharmacovigilance & Medical Information
Automate adverse event intake, MedDRA coding, MI inquiry handling, and compliance checks—end to end.

Key Benefits

Faster case processing
Fewer manual hand-offs
Always inspection-ready

AI Handles

  • Extract details from emails, faxes, call transcripts, and literature sources
  • Auto-code symptoms using MedDRA; flag duplicates
  • Draft structured case narratives and safety database entries

Human Focuses On

  • Quality control of coded cases and drafted narratives
  • Final review of serious cases (physician/pharmacist oversight)
  • Complex inquiry escalation and call handling
6 weeks to full production
Healthcare
Claims Processing / RCM
Automate coding, assemble clean claims, and overturn denials—end to end.

Key Benefits

Clean-claim rate ≥98%
Initial denials ↓
Days in A/R ↓
Net collections ↑

AI Handles

  • Read charts; propose ICD-10/CPT/HCPCS + modifiers; NCCI edits
  • Build X12 837; payer-specific scrub; submit via clearinghouse
  • Parse 835 ERAs; map CARC/RARC; auto-post remits; flag variances

Human Focuses On

  • Coder QA for complex encounters
  • Payer calls/IVRs; documentation follow-ups; negotiation on recoups/under-pays
  • Appeal packet finalization; payer-specific playbooks; root-cause fixes
4 weeks to full production
Healthcare
Patient Contact Center
Scale reminders, scheduling, and billing Q&A—compliant, multi-channel.

Key Benefits

No-show rate ↓
Reach & right-party contact ↑
First-call resolution ↑
Avg. hold time ↓

AI Handles

  • Proactive reminders (voice/SMS) with prep instructions; waitlist backfill
  • Two-way billing Q&A with consent & opt-out; payment-plan offers
  • Insurance benefit scripts from 271/plan rules; auth-needed flags

Human Focuses On

  • Clinical/sensitive conversations, escalations, complaints
  • Financial counseling & complex billing issues
  • Edge-case scheduling and physician preference handling
4 weeks to full campaigns
Insurance
Claims Processing
Cut cycle time from FNOL to settlement; lower leakage with automated checks.

Key Benefits

Cycle time ↓
Indemnity & expense leakage ↓
NPS ↑
Fraud false-positives ↓

AI Handles

  • Omnichannel FNOL intake (voice/chat); document ingestion & data extraction
  • Coverage validation vs policy terms; rules + AI triage (repair/replace/total)
  • Fraud signals (network links, anomaly scores); subrogation opportunity hints

Human Focuses On

  • Complex liability determination; negotiation; sensitive customer comms
  • Large/complex losses; litigation, SIU investigations
  • Authority-limit approvals and exceptions
6 weeks to top 3 LOBs

Ready to Transform Your Operations?

See how AIBPO can automate your specific workflows. Schedule a demo to explore custom AI solutions tailored to your business needs.