Claims Processing

Insurance

Claims processing is the ultimate candidate for workflow technology. A workflow system can streamline and track tasks, enforce discipline and timelines, bring real-time visibility to operations and measure individual/team productivity. However, customer’s existing legacy environment and entrenched processes often prohibit radical changes like system replacement. Workflow technology couple with a rules engine can be used to process certain type of claims without manual intervention.To extract real competitive advantage and significant cost reduction, one needs incremental transformation of the entire process while leveraging existing IT infrastructure. Visionet is best at optimizing existing claims processing systems by wrapping them with a workflow queue management system.

Visionet Systems has significant experience in using workflow and portal technology enablers in various claims processing environments. As we have begun to apply new thinking and new tools to older processes, we have developed a framework for superior claims process. In this new process:

Exception based management with significant process automation is employed
Rules based claims processing automation under specified preset limits
Automated task tracking and individual/team productivity measurements are built into the system
Intelligent electronic templates are used for documentation based on (ACORD) industry standard forms
ACORD XML/EDI-AL3 based standards are used for standardizing data interchange within the process and with external systems
Web services based technology architecture enables the insurance carrier to seamlessly collect information from disparate internal and external sources
Electronic forms coupled with workflow capabilities capable of triggering multiple delivery mechanisms like print, email, electronic archival and retrieval
Tracking of claims status through Web or email/mobile phone alerts to the parties involved at various stages of the process

The benefits of Visionet Systems Claims Processing Solution Framework are:

Significantly reduced claims-related expenses and cycle time
Reduced loss costs through better decision making and information consistency
Improved quality, a better customer experience and higher customer satisfaction and retention
Leveraging existing IT infrastructure to deliver business benefits, without demanding aggressive investments
Outsourcing and in-house operations management from a single portal

A typical claim currently takes over 20 days to process. The majority of this processing time, about 14 days, is spent waiting for tasks or processes to be performed. Tasks follow up can be automated through workflow technologies so that action is prompted by either through work queue management or alerts. Significant time reductions are possible through selective outsourcing of vendor follow-up. Workflow enabled process can then automatically trigger the next task once the pending task is complete.

In brief, the application of these technologies is transforming the claims processing operations while posting dramatic increases in efficiency and effectiveness. Fast and efficient claims processing can drive positive customer interactions and control losses and claims handling expenses.

Simplified ROI Model

Off the shelf use of Workflow, Web Based Access, Executive Dashboards, Intelligent Documents (ACORD) and Web Services components

Cost Savings

Reduce FTEs
Eliminate re-keying of information
Reduce claims handling cycle time by automating follow up
Reduce re-work and repetitive verification of information
Benchmark vendors and proactively manage SLAs

Revenue Enhancements

Improve quality of claims process operations
Improve customer retention through better service
Stimulate additional revenue (cross/up sell) through service performance improvement