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Applied Sciences OPEN ACCESS

Robotic Process Automation in Pharmacy Benefit Manager (PBM) Quality

Sravan Kumar Nidiganti
Senior Manager - Operational Excellence & Quality Management, TCoE-Benefits & Clinical Operations, CVS Health, USA
DOI Crossref DOI 10.37547/tajas/Volume07Issue07-10
tajas 2025
VOL. 7 / NO. 07 JULY
FULL TEXT PP. 93-100
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VOLUME 7
ISSUE 07
YEAR 2025
PAGES 93-100
RESEARCH OVERVIEW

Abstract

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.

RESEARCH TOPICS

Keywords

Pharmacy Benefit Management (PBM) Robotic Process Automation (RPA) Artificial Intelligence (AI) Machine Learning (ML)

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