INSURANCE
Eligibility + enrollment process automation
Insurers manage vast amounts of applicant data during the eligibility and enrollment phases. This data, often submitted in various formats such as CSV or Excel, must be validated and transformed to meet compliance requirements before policy issuance. However, manual data handling can introduce errors, delays, and operational inefficiencies.
Industry challenge
The Eligibility and Enrollment Process in the insurance industry is often hindered by data inconsistencies, seasonal demands, and ever-changing client requirements. Insurers frequently receive applicant data from multiple sources in varied formats, making it difficult to maintain accuracy, efficiency, and compliance without significant manual intervention.
Bordereaux files and applicant data often arrive in non-standard formats that vary across clients and over time. Schema changes during submissions create mapping challenges, requiring insurers to constantly adjust their processes, leading to delays and errors.
Schema shifts and data inconsistency
During peak enrollment periods, insurers face a surge in data submissions that overwhelm manual workflows. This can result in processing backlogs, missed deadlines, and inaccurate eligibility checks, ultimately impacting customer satisfaction and compliance.
Peak season demands
Onboarding new clients brings unique challenges, such as handling custom eligibility criteria and different file structures. The lack of a standardized approach to data ingestion and transformation results in long onboarding times and higher operational costs.
New client onboarding
HerculesAI for eligibility and enrollment process automation
HerculesAI automates the data extraction, transformation, and verification needed for the eligibility evaluation process. By streamlining the ingestion of applicant data from various sources, the solution automatically converts files into standardized templates and validates the data to ensure accurate and compliant outputs.
This process eliminates manual intervention, enabling insurers to define coverage options more efficiently. With HerculesAI, insurers can achieve fast, consistent, and accurate data processing that integrates seamlessly into downstream systems.
THE STATS
80x
faster automatically ingest and validate applicant data in real-time
90%
reduction in manual data mapping
99%
accuracy in standardizing output
Seamless intervention at key process stages
Managing eligibility and enrollment in the insurance industry requires processing large volumes of data from group clients, such as employers or associations, who submit applicant information for coverage. These files arrive in varied formats—such as CSV, Excel, and XML—and must be accurately transformed into a standardized template that aligns with policy administration or underwriting platform requirements.
AI CAPABILITY
Automatically detects file formats, validates data, and handles schema variations without manual intervention
01
Data submission
Group customers and clients send bulk applicant data in various formats and schemas
AI CAPABILITY
Maps data fields to a predefined template, adjusts for schema shifts, and transforms files into a compliant format
02
Schema mapping and transformation
Each client’s data structure differs and must be standardized for system injection
AI CAPABILITY
Validates data against eligibility criteria and ensures seamless integration into downstream systems
03
Eligibility verification and policy injection
Verified data is injected into policy admin, underwriting, or eligibility systems
AI CAPABILITY
Learns from user adjustments to improve accuracy over time and handle edge cases automatically in future submissions
04
Continuous improvement
Unique client cases and unexpected data formats can create edge cases
Key features
Speeds up processing
Delivers read-to-use, standardized data for faster policy issuance
Our clients are saving time, reducing costs, and minimizing compliance risks every day. Hercules provides scalable processes that allow insurers to handle peak-season demands without needing to add more resources or strain existing teams.
