Open enrolment is the time of year when health plans welcome new members, renew existing ones, and make sure every change is recorded cleanly. In practice, it can feel like a sprint and a maze at once. Forms arrive in different formats, questions pile up, deadlines don’t move, and small errors early on can ripple through billing and compliance later. This is where open enrolment automation steps in. It reads what comes in, checks it, and routes it.
The process is fairly simple. Tools like OCR (optical character recognition) and ICR (intelligent character recognition) pull data from scanned and handwritten forms as well as digital submissions. Automated data recognition and machine learning then match fields to the right records, flag gaps, and send each item to the right queue, improving both speed and efficiency. This factor is especially pivotal, considering the growing volume of enrolments.
When enrolment volumes rise to high levels, speed on its own is not the answer; accuracy and speed have to move together. And, automation is the only answer.
In fact, some payers are taking it further, applying the same automation principles to value-based care (VBC) platforms. These cloud-based systems consolidate member enrolment, premium billing, revenue reconciliation, quality improvement, and risk adjustment in one interface. When applications, billing history, and diagnosis information sit side by side, it’s easier to spot eligibility gaps and missing documentation early. Dashboards update in near real time, so teams can manage by exception: fix what needs attention today instead of discovering it at month-end. Diagnosis information can also be checked against coding logic on the spot, improving confidence in member scoring and payment alignment without layering on new manual checks.
The outcomes of this transformation are visible not only in productivity metrics but also in member experience. When platforms operate in real time, enrolment errors are flagged instantly, allowing for smoother onboarding and fewer back-and-forths with members. Equally important is what automation allows teams to stop doing – manual tracking, repetitive form reviews, and endless spreadsheet cross-checking. Instead, staff can focus on closing care gaps, supporting providers, and improving quality metrics. Time saved becomes time reinvested into strategic value-based goals.
Having said that, bringing this transformation isn’t just about deploying tools. Until these tools are combined with deep domain expertise, they will not yield the desired results. Technology matters, but so does the operational intelligence that surrounds it. Therefore, leading payers need to choose partners who can configure the platform, map legacy workflows to new systems, train users, and guide regulatory alignment from day one. Here are some more checkpoints for leaders to consider while opting for open enrolment automation:
- Centralise data. Bring billing and reconciliation into the same view as enrolment to handle delinquencies, discrepancies, and adjustments without handoffs.
- Use real-time dashboards to manage by exception and resolve gaps the day they appear.
- Automate key workflows, such as eligibility, invoicing, and reconciliation.
- Prioritise continuous quality, not just seasonal performance.
- Keep training tight and role-specific so teams adopt new queues and rules quickly.
- Ensure compliance is built in: let the platform maintain an audit trail automatically as work happens, reducing the need for manual evidence packs.
Remember, clean intake can set the tone for the whole season. Open enrolment automation may not change the calendar, but it can definitely change the experience. Healthcare payers that move fast and implement open enrolment automation along with value-based care systems will not only streamline enrolment but also set the foundation for more member-centric health plans.
how Infosys BPM can help
Backed by a 1,400+ strong insurance practice and experience with over 45 global insurers, Infosys BPM’s insurance services bring deep domain expertise to healthcare payers navigating the complex open enrolment season. It helps streamline enrolment, billing, compliance, and member communication through scalable, insight-led solutions. With proven success across life, group, and speciality insurance segments, Infosys BPM is the partner of choice for payers aiming to modernise their enrolment cycles and deliver more member-centric health plans.
