Did you know that a cloud-based claim processing software solution can improve claim processing efficiency by 30%? That’s what one large insurance carrier in the US found after moving their claim processing to a cloud-based solution. Some of the benefits realized include:

  • Time freed up for claims administrators to spend more time on managing the more challenging claims
  • The number of claims processed increased with the same number of employees
  • Reduced processing and elapsed time from intake to payment.

Naturally, when processing a claim, it should be the aim of any insurer to make the process as uncomplicated and hassle-free for the claimant as possible. Dragging out the payment process unnecessarily, or requesting additional or duplicate information can add more stress to an already stressful time.

Paper-based claims departments using manual processes are inherently inefficient, and there is a significant risk of losing critical claim data. Not to mention the silos of data that don’t talk to each other but merely exist in isolation. Duplicate data entry adds time and cost to the claims process, forcing claims administrators to multiply the number of keystrokes per transaction – frustrating both your admin staff and the claimant who expects the claims department to have all of the relevant details to hand.

Digitizing the claims process to introduce a centralized database with electronic file storage is the future of your claims department. All claims administrators, call center staff, and claims managers can view all claims data in real-time, ensuring the most up to date data is being provided at any time.

Nothing new there, you might say. But what has changed is that the digital economy gives you the opportunity to collate claims data from external sources (including the claimant) directly into the claims process. Offering claimant portals or apps ensures that the data entry element is pretty much already taken care of without the need for your staff to rekey it.

Reducing claims intake effort begins to increase efficiency. Further streamlining can be gained by replacing manual tasks and introducing automated workflows and tasks to trigger once a claim is created. Automated tasks ensure the right person is taking necessary steps at the right time with the right supporting information available.

Based on historical data, you should be able to identify particular diagnoses that would support auto-adjudication, speeding up the process even further. For example, based on the diagnosis code for a particular disease you might decide to auto-adjudicate that claim and issue the payment without further investigation. Contrary to that, certain causes or diagnoses might trigger other tasks, ensuring your claims administrators are investigating any potentially fraudulent claims or policy exclusions. Having the data held digitally in a structured way gives you the opportunity to exploit the data mining technologies available to identify trends and act accordingly

The final piece of the claims puzzle is payments. Adjudicating the benefits right through to automated payments is an ideal solution, although most insurers have a claims administrator sign off the claim before issuing payment. Being able to automate the payment process to multiple payees (beneficiaries, medical providers, etc.) can significantly reduce administrative effort compared to setting up and authorizing payments one by one.

The case for a cloud-based technology platform is often compelling. Having a system that is hosted and maintained by specialists can reduce the strain on your IT team, leaving them free to add value to the business in other ways. Perhaps more significant though is that a cloud platform is always current and doesn’t get left behind, allowing you to take advantage of new technologies as they emerge.

Increasing claim processing efficiency improves competitive advantage 

Social media and comparison sites mean that not only is improving claim processing efficiency good for your customer experience and your internal teams, but it can improve your competitive advantage. Firstly, your brand image will improve as your customer experience excels. Secondly, you can process more claims more quickly and accurately without increasing your resources, proving an effective ROI.

The key though is to embrace digital. If digitizing your claims process isn’t at the forefront of your mind consider the implications of your competitor getting there first. For further reading, we encourage you to take a look at our blog on the known roadblocks to digitizing the claims process.

Be prepared to disrupt your claims department to produce better results!