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DOI: Robotic Process Automation in Pharmacy Benefit Manager (PBM) Quality
Sravan Kumar Nidiganti , Senior Manager - Operational Excellence & Quality Management, TCoE-Benefits & Clinical Operations, CVS Health, USAAbstract
The Increased complexity of Pharmacy Benefit Management (PBM) and the growing focus on lowering administrative expenses have expedited the search for Robotic Process Automation (RPA). This paper provides a comprehensive analysis of implementing RPA in PBM quality, focusing on core challenges such as claims adjudication, prior authorization, and audit preparation. When AI, ML, and RPA technologies work together, they become smarter and more scalable, which makes it easier to make decisions and follow the compliance rules. This paper briefs the benefits, challenges, and outcomes of intelligent automation in PBM Quality through case studies and literature review.
Keywords
Pharmacy Benefit Management (PBM), Robotic Process Automation (RPA), Artificial Intelligence (AI), Machine Learning (ML)
References
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Copyright (c) 2025 Sravan Kumar Nidiganti
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