Reduce FTEs for Eligibility Verification and Claim Status Calls

Healthcare revenue cycle teams are drowning in phone calls to payers. Eligibility verification and claim status inquiries, though routine, consume an outsized share of administrative bandwidth. For many organizations, the only way to keep up has been to hire more full-time employees (FTEs)—but this approach is expensive, inefficient, and unsustainable.

The solution isn’t to add more staff. It’s to automate. Advances in agentic AI and voice automation now make it possible to handle these repetitive phone calls at scale, freeing staff to focus on high-value work while improving revenue cycle performance.

Why Manual Payer Calls Drain Resources

Eligibility and claim status calls are both high-volume and high-friction. According to the CAQH Index:

• The average cost of a manual eligibility verification is $10.37 per transaction, compared to $0.48 for an automated one.
  
  
• Manual claim status inquiries cost $11.12 per transaction, versus $1.89 with automation.
  
  

These costs add up quickly for providers handling thousands of calls each month. Beyond financial impact, manual workflows create:

• Extended hold times and slow processing that delay patient care and reimbursements
  
  
• Staff burnout from repetitive phone work
  
  
• Risk of human error in data entry or payer interpretation
  
  
• Limited scalability—hiring additional staff becomes the only path to manage volume
  
  

The Case for Automation

Unlike traditional call-center outsourcing or EDI transactions, agentic AI automation addresses the problem at its root: by replacing repetitive manual calls with intelligent, voice-capable AI agents.

These AI agents can:

• Call payer lines, navigate IVRs, and wait on hold automatically
  
  
• Communicate with payer representatives to retrieve eligibility and claim status details
  
  
• Update patient records and claims management systems in real-time
  
  
• Escalate exceptions to human staff for review
  
  

This approach dramatically cuts the number of hours staff must spend on the phone—without sacrificing compliance or accuracy.

How Automation Reduces FTE Requirements

Automation reshapes the economics of administrative staffing:

Manual Process

Automated Process

5–10 FTEs handle payer calls daily

1–2 staff manage AI-driven workflows

Staff manually log call results

AI agents record and push results into RCM/EHR

Calls handled one at a time

Dozens of calls processed in parallel

Frequent follow-ups required

AI auto-schedules follow-ups and rechecks

High risk of error

Standardized, rules-based call handling

By replacing routine call work with automation, providers can repurpose or reduce FTEs while improving throughput and cash flow.

A Step-by-Step Approach to Implementing Automation

Assess Your Call Volume and Costs

Start by tracking the total time and FTE hours spent on eligibility and claim status calls. This creates a baseline to measure ROI.

Identify High-Impact Payers

Focus first on payers with the highest call volume and longest hold times—this is where automation will deliver the fastest return.

Deploy Agentic AI Call Automation

Select a HIPAA-compliant platform with voice AI, EHR integration, and payer-specific workflow support. Configure it to mirror your existing call scripts and escalation rules.

Pilot and Validate

Begin with a small set of payers or workflows (e.g., claim status only). Measure accuracy, compliance, and time savings before scaling.

Expand and Optimize

Once validated, expand to eligibility calls and additional payers. Continuously monitor performance data to fine-tune workflows.

Advanced Use Cases for Automation

Beyond standard eligibility and claim status calls, automation can also:

• Pre-verify eligibility before appointments, reducing front-office delays
  
  
• Auto-flag discrepancies between payer data and submitted claims
  
  
• Schedule recurring status checks for claims stuck in adjudication
  
  
• Generate exception reports for staff review, focusing human effort only where it’s needed
  
  

By automating the repetitive, providers free their teams to focus on solving complex claim denials, appeals, and higher-value RCM work.

Compliance and Security Considerations

When automating payer calls that involve PHI (Protected Health Information), compliance is non-negotiable. Best practices include:

• Ensuring your automation platform is HIPAA-compliant
  
  
• Using encrypted call logs and data transfers
  
  
• Maintaining a full audit trail for every call interaction
  
  
• Establishing clear human review checkpoints for exceptions
  
  

These safeguards ensure automation supports compliance while reducing administrative overhead.

The ROI of Reducing FTEs with Automation

The financial benefits of automating payer calls are significant:

• 30–50% reduction in FTE hours spent on eligibility and claim status calls
  
  
• Improved accuracy, reducing claim denials and rework
  
  
• Lower operational costs, as fewer staff are required for repetitive tasks
  
  
• Faster reimbursement cycles, improving cash flow
  
  

For mid-sized practices, these gains translate into hundreds of hours saved per month and substantial reductions in staffing costs.

How SuperDial Makes It Possible

SuperDial’s agentic AI platform enables providers to:

• Automate payer calls for eligibility verification and claim status
  
  
• Integrate results directly into EHR and RCM workflows
  
  
• Reduce manual follow-ups with automated re-check scheduling
  
  
• Monitor every call with robust compliance reporting
  
  

Instead of growing your administrative team, you can let SuperDial’s automation do the heavy lifting—reducing FTE requirements while improving revenue cycle efficiency.

From Staffing Burden to Scalable Automation

Healthcare providers don’t need to solve rising administrative costs with endless hiring. By adopting payer call automation, you can reduce FTEs, cut costs, and focus human expertise on the work that matters most.

Ready to eliminate manual eligibility and claim status calls? Contact SuperDial today to learn how our agentic AI platform can transform your administrative workflows.

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