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.
FAQ
The primary bottlenecks are the massive seasonal surges of unstructured data (scanned PDFs, faxes, and handwritten forms) and the high rate of manual eligibility verification. These manual touchpoints slow down the "request-to-active" cycle, leading to backlogs that can negatively impact a payer’s CMS Star Ratings and member onboarding experience. Transitioning to automated open enrolment solutions allows for real-time data recognition and straight-through processing (STP) of standard applications.
Automation eliminates manual reconciliation errors by providing a single source of truth that links member enrolment data directly to billing systems. Automated workflows flag eligibility gaps and payment discrepancies in near real-time, allowing teams to "manage by exception" rather than cross-checking endless spreadsheets. This systematic accuracy reduces administrative leakage and ensures that revenue is reconciled daily, which is essential for maintaining fiscal health during high-volume periods.
Yes. CMS Star Ratings are heavily influenced by the speed and accuracy of enrolment processing and the quality of member communications. Automation ensures that enrolment submissions meet strict federal deadlines and reduces the friction of member onboarding. By automating 95% of member correspondence and status updates, payers can provide a more responsive experience that drives higher member satisfaction scores, a key component of the Star Rating framework.
Healthcare organizations typically achieve ROI through a 40–60% reduction in administrative costs and the elimination of the "surge hiring" costs associated with seasonal temporary staff. Furthermore, automated systems can reduce error rates to less than 1%, preventing the downstream costs of corrected claims and billing disputes. The efficiency gains allow payers to reallocate skilled human capital to strategic initiatives like value-based care (VBC) and clinical gap closure.
