Context
A large health insurance TPA processed high volumes of pre-authorization requests across hospitals, insurers, and internal clinical teams. Turnaround time and manual touchpoints affected provider experience and operational cost.
Business problem
Pre-auth queues grew with network expansion. Teams relied on fragmented rules, manual document review, and inconsistent prioritization—creating delays on both fresh and discharge cases.
User or operational pain
Operations leaders faced rising AHT, insurer concurrence delays, and limited visibility into bottlenecks. Hospital partners escalated slow responses; internal teams burned capacity on repeatable checks.
Product intervention
Product-led workflow modernization: rule sequencing, auto-allocation, concurrence automation, productivity instrumentation, and AI-assisted document understanding layered on existing systems of record.
AI capability used
Document classification, OCR and extraction, clinical and billing signal summarization, decision-support recommendations, and governed automation with human approval gates.
Samadhan's role
Samadhan led product strategy and execution as AI Product Leader: workflow mapping with operations, PRD and success metrics, pilot design, stakeholder alignment with clinical and insurer teams, and rollout governance.
Business outcome
Measurable improvements in pre-auth AHT, fresh and discharge TAT, and team productivity—with clearer escalation paths and audit-friendly decision trails.
Lessons for other companies
Start with workflow truth, not model demos. Automate the repeatable middle; keep humans on exceptions. Instrument every stage before scaling AI.
Related service: Healthcare AI Product Consulting · Insights
Ready to move from AI pilots to production?
Share your workflow, constraints, and timeline. I will respond with a clear view on fit, approach, and next steps.