Client: Medical arbitration and collections firm

Client's Goals: Implement a scalable, automated system that efficiently manages high volumes of healthcare claims and dispute-related emails.

Our Team's Role: Citrin Cooperman designed and implemented a scalable, AI-driven automation solution using Microsoft Dynamics 365 and Power Automate that streamlined the client’s email processing, claim lifecycle management, and task coordination — enhancing accuracy, compliance, and operational efficiency across their arbitration and independent dispute resolution (IDR) workflows.

A specialized medical arbitration and collections firm transformed its claims dispute resolution process by leveraging Microsoft Dynamics 365, Power Automate, and AI Builder. Facing a high volume of complex emails related to healthcare claims, disputes, and arbitration, the client implemented an intelligent, rule-based automation system to orchestrate email workflows and manage claim lifecycle transitions. This shift eliminated manual tracking, reduced errors, and closed compliance gaps. By embedding AI-driven automation into daily operations, the client moved from reactive case handling to a proactive, scalable approach — enhancing speed, accuracy, and transparency across its arbitration and independent dispute resolution (IDR) workflows.

Challenges

• The client faced a high volume of emails tied to healthcare claims, disputes, IDR entities, and arbitration, each requiring specific business actions.
• Manual processing led to delays, missed deadlines, and compliance risks due to inconsistent tracking.
• Each message triggered CRM updates or task creation, often needing human intervention to manage claim and dispute lifecycles.
• A scalable, rules-based solution was needed to automate lifecycle transitions, track dispute statuses, and ensure timely responses.

Citrin Cooperman's Approach

• Implement a Power Automate flow that scans arbitration emails, extracts key details, and determines next steps based on keywords like claim and dispute numbers.
• Configure the system to update claim and dispute stages in Dynamics 365 based on email content, adjusting statuses, due dates, and payment values.
• Enable the flow to flag missing data, prompt user input, and guide users through resolving issues before resubmission.
• Setup automated reminders for stakeholders and configured the system to generate prioritized CRM tasks to support timely action.

Results

• Streamlined Workflows: The “Claim Tracker” app automated arbitration and IDR processes, reducing manual effort and improving operational efficiency.
• Enhanced Data Accuracy: Intelligent email parsing keeps records current, minimizing errors, and ensuring reliable data.
• Improved Accountability: Automated task creation and deadline alerts keep stakeholders aligned and responsive throughout the claim lifecycle.
• Scalable and Transparent Operations: The solution supports growing volumes while maintaining full visibility with a comprehensive audit trail and email timeline.