4 Ways to Break the Speed vs. Accuracy Conundrum in Claims

By Virender Jeet Senior Vice President, Sales & Marketing / Products, Newgen Software

Claims processing is an inherently complex process and the heterogeneity of scenarios involved complicates it further. To add to the challenge, customers expect claims settlement to be both fast and accurate, which is a challenging feat for insurers. This leaves insurers looking for ways to make claims settlement faster and more effective. To achieve this, breaking the Speed vs. Accuracy Conundrum becomes imperative for insurers.

Factors That Affect Speed and Accuracy

Several factors stand in the way of accomplishing Speed and Accuracy in claims processing. The major factors that slow down the process include Manual and Broken Processes, and Disjointed Social and Mobility Channels. Whereas, the major impediments to accuracy include Paper Intensiveness, Data Loses and Gaps, Ineffective Decision Making, and Inadequate Audit Strategy.

Breaking the Speed vs. Accuracy Conundrum

Virender Jeet, Senior Vice President, Sales & Marketing / Products, Newgen Software

Digitally transforming the claims process is the key to breaking the Speed and Accuracy Conundrum. Insurance organizations need to create a comprehensive digital transformation strategy based on the following guidelines –

1. Automate Workflow

 An automated workflow is a solution to many of the above-mentioned challenges. It improves visibility and control, breaks down process silos, automates manual tasks improving accuracy and duplication of data.

When a claims process is automated, identification of bottlenecks becomes easier. Moreover, when combined with a rules engine, the percentage of straight-through cases also increases incrementally. And, all this is executed based on historical analysis and claims classification, sans manual intervention.

2. Automate Rules and Decisions

Claims settlement is a rules and policy-driven process. The variations and complexities involved in this process are often beyond human control. In such a scenario, automation through a rules engine improves the overall performance drastically. This is achieved by eliminating human involvement in routine and repetitive tasks.

Rules based automation also allows for intelligent decision-making in special scenarios. Scenarios that require human expertise are routed for human intervention. This improves both the speed and accuracy of the settlement process.

3. Inculcate Flexibility

One of the components that play a critical role in balancing speed and accuracy is Flexibility. And, to accomplish flexibility, it is essential to allow human decision making in complex scenarios. This can be achieved with a dynamic case management technology, which offers intelligent workflow routing in not only structured but also unstructured scenarios.

In an automated claims process, a dynamic case management technology introduces additional flexibility by allowing ad-hoc routing and in-process collaboration.

4. Implement Straight through Processing

Unless the back and front end processes are integrated thoroughly, the claims settlement process will require swivel chair human intervention. Further, weak data integration would also result in data gaps and errors, resulting in a loss of speed.

To avoid this, the claims processing platform would require relevant interfaces for external parties (such as surveyors and garages) for real-time submission of data and documents. Further, to ensure timely triggers for outgoing and incoming communication, a smart integration approach is required. This approach would ensure event-driven tracking for outgoing emails and auto-ingestion of incoming emails.

Conclusion

In order to break the Speed vs. Accuracy conundrum, it is essential to view claims as an end-to-end process. Insurance organizations require a paperless, automated process that allows documents and data to move alongside each other. Further, it is essential to support this process with a configurable process platform that joins the systems and functions comprehensively.