Medical Expenses Reimbursement – Increased Volume and Fraud Reduction


  • From 9,000 manually processed reimbursements per month to 53,000 reimbursements per month with automation;
  • From 6 minutes per reimbursement processed manually to 3 minutes per reimbursement;
  • 32,000 invoices per month verified at an approximate value of R$14 million per month; previously, no invoices were verified, and all received cases were paid;
  • Approximately saved R$1.3 million per month from errors and potential frauds;
  • Automation via screen using the current systems of the Health Operator;
  • Hiring as a service, without software purchase or licenses.

Our Medical Expense Reimbursement Automation solution for Health Operators is an innovative IT service that revolutionizes how companies handle the complex process of medical expense reimbursement. Focused on efficiency and accuracy, this automated solution streamlines everything from invoice verification to reimbursement approval, saving time and resources while reducing operational errors.

In the past 90 days, our automation solution processed an impressive volume of 160,000 cases at a major Health Operator, with an average time of just 3 minutes per case. This agility is a testament to the effectiveness of the automated process, enabling teams to focus on strategic tasks rather than repetitive and time-consuming ones.

During this period, over 95,000 invoices totaling R$43 million were verified. Automation ensured accurate and efficient evaluation of each invoice, eliminating the likelihood of human errors and ensuring all information is processed correctly. This not only speeds up the process but also reduces the possibility of incorrect payments.

A total of R$4 million was saved due to errors found in the invoices corresponding to the reimbursements.

Key errors detected:

  • Divergence between Invoice Value and Reimbursement: We identified over 2,000 invoices with discrepancies in values, totaling R$2 million.
  • Errors in Invoice Numbers or Verification Codes: We found over 20,000 invoices with errors in numbers or codes, totaling R$1.6 million. Automation validates these fields, minimizing errors and rejecting cases with incorrect information.
  • Cancelled Invoice: We identified over 130 cancelled invoices, totaling R$200,000. Automation automatically checks the status of invoices and prevents the processing of improper reimbursements.

These examples highlight how automation of the Medical Expense Reimbursement process increases accuracy and eliminates errors, potentially reducing frauds and inconsistencies.

The Medical Expense Reimbursement Automation solution provides an efficient and accurate approach for companies seeking to streamline their financial processes related to medical expenses. By processing a large volume of cases and automatically identifying irregularities, this solution represents a valuable opportunity to enhance operational efficiency and save resources. By embracing this automation, companies can expect positive financial outcomes, optimized operations, and more effective and reliable financial management.

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