Problem Statement

A health plan receives enrollment applications through many separate channels - brokers, marketplaces, and enrollment platforms - and each drops its files onto its own network drive in its own format. Before any application can be processed into coverage, every file has to be gathered from those sources and loaded into the approval-screening step, and the count of records going in has to be reconciled against what the system confirms it received. Done manually across eight-plus sources, this is slow and error-prone, and a file that loads partially or gets missed means applicants who tried to enroll are silently left unprocessed, delaying or denying their coverage.

Automation Solution

This automation retrieves enrollment application files from each vendor network drive, counts the records in each file, uploads them for Gold Approval screening (submitting all CMS files together), verifies against the confirmation number that every record loaded successfully, and emails the distribution list the automation status.