How Major Healthcare Payers are Automating Open Enrollment
Advanced digital capabilities take the stress out of the busiest time of the year.
In our work with many of the nation’s largest healthcare payers, we’ve found that late summer and early fall are among the busiest times of year, as plans gear up for open enrollment. It’s also when partners like Conduent ramp up support to help ensure a smooth season. One of the biggest challenges during open enrollment is the sheer volume of forms. In large commercial businesses, many of those forms are completed electronically. For Medicare enrollments, however, the process is still largely done through handwritten forms sent via fax.
“By 2024, more than 32 million people were enrolled in Medicare Advantage plans, accounting for over 54% of the total Medicare population 1. While digital enrollment options have grown, many beneficiaries still rely on paper-based processes, underscoring the continued need for modernization in healthcare administration.”
Source: Medicare Advantage in 2024: Enrollment Update and Key Trends | KFF
While open enrollment processing gets done each year, we see a significant opportunity to make it more seamless, efficient, and cost-effective for both health plans and the members they serve.
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Managing volume — and the need for speed
The Centers for Medicaid and Medicare Services (CMS) have strict submission guidelines for processing enrollments. Missing those deadlines can impjact a payer’s CMS Star Ratings, which can result in lower reimbursement amounts later. Accordingly, expedient processing is of enormous importance to payers.
Managing the sheer volume of enrollments quickly, efficiently and accurately requires sophisticated technology and an experienced workforce. At Conduent, we produce OCR rates in excess of 99% while achieving STP of 95%+ and we continue to make enhancements to deliver maximum speed and accuracy for our clients.
Machine learning and AI have changed the game
New technologies have had a major impact on an organization’s ability to manage paper documents, but strategic and effective implementation is crucial.
By integrating advanced machine learning, OCR, ICR and ADR into our document management automation platform, we’ve dramatically improved the speed and accuracy of processing both semi-structured and unstructured documents. This is critical during peak open enrollment, but just as valuable during slower periods while ensuring continued accuracy while unlocking new opportunities for efficiency and cost savings.
Reducing open enrollment labor requirements and overall costs
While healthcare payers are always looking for operational efficiencies, open enrollment has long been an area in need of transformation. Traditionally, it has required a sharp increase in temporary staffing to manage the surge in volume followed by equally significant reductions once the busy season ends. Conduent manages these cyclical staffing needs on behalf of our clients-through our scalable staffing-models-—-and-the efficiencies we create are passed along to our customers.--
By bringing greater automation to the open enrollment process, organizations can decrease their labor requirements and spending while realizing a greater return on investment. In fact, one of the-major healthcare companies achieved a 15-fold increase in overall processing times during open enrollment. They also decreased their full-time staffing requirements by more than 80%.
Modernizing enrollment operations for today’s demands
As the healthcare landscape continues to evolve, so too must the systems that support it. Open enrollment remains one of the most operationally intense periods of the year, and success hinges on having the right technology and expertise in place.
Today’s leading healthcare organizations are looking beyond traditional models and embracing partners who can offer flexible, scalable solutions that align with a digital-first strategy. Whether it’s managing high volumes of paper-based forms or integrating automation to streamline workflows, the right partner brings both the tools and the experience to adapt quickly and deliver consistent results.
When evaluating a partner, it’s important to consider their ability to support modern processing methods—like intelligent document automation, machine learning, and high-accuracy OCR—while also offering operational agility. These capabilities are essential not just during peak enrollment periods, but year-round, as expectations for speed, accuracy, and compliance continue to rise.
Want to learn more about how document management and automation can drive your business forward? Visit our website-and check out our eBook:-How Automation is Powering Agility in Document Management.