Claims System Automation

Case Studies

Insurance

Business Process Modeling and Automation of Insurance Claims Processing System.

Corporate Profile

Leading Insurance Company operates in multiple states and provides insurance to multiple lines of business.

Business Challenge

Provide interactive Rule based flexible paperless claims workflow from claim generation to closing.

Solution

To develop flexible rule based insurance claims workflow processing for lines of business including commercial lines, Home owners, workers compensation and Auto Insurance.

Results

Increase customer satisfaction by decreasing claims processing time from 60 to 35 days. It generates annual savings of $336,000 by decreasing customer service calls, reduced number of legal actions and efficient business process workflow automation that eliminates lot of paperwork and unnecessary steps. 6 Months payback on Investment.

The problem of a manual claim workflow was:

Duplicate work
Difficulty in keeping track of assignments
No standard processes
Inefficient customer service
No physical backups of the data
Lack of MIS reports

The result of a manual claim workflow was:
Unacceptable delays
Deadline slippages
Unsatisfied customers
Unacceptable business performance
Lack of substantive opportunities for growth in revenue and profitability

Visionet’s team reviewed and revitalized the claims processing, starting from Claim generation to Claim settlement in an effective and efficient way. This resulted in reducing the Claim processing time, revitalizing the company’s claim process and its employees, increased loyalty and retention of the company’s policy holders and agents, higher revenue growth and profitability, efficient customer service, provided opportunity for the upper management to evaluate the performance of overall process, established standard and processes that did not only reduce the risk of inconsistent results but also reduced the dependency on employees, decreased operational cost, achieved employee interchangeability, established standard processes within a specific business line for all employees.

Online claim filing facility allows claimant to fill and submit the ACORD form online. This resulted in claimant get the claim number instantaneously, 24 by 7 claim filing facility, online tracking of the claim processing, auto claim assignment to an appropriate claim processing division by claim type, and elimination of a manual claim filing task from the employees task list.

A database driven Workflow Engine enables the users to define/modify the complex business rules and conditions to quickly respond to the changes in business process. These business conditions are associated with the relevant tasks in a business process which will allow the management to audit/track at a grass roots level.

Auto task assignment facility distributes the work among team players by analyzing the existing workload of a team player. Users can manage their workloads using their work queues.