How Automation Transforms Claims Processing Workflow
Introduction
It's a well known fact that claims operations are the most critical and highly confidential workflows that operate within any insurance company.
However, the insurance claim processing workflow is usually very tedious, slow and time consuming by nature and are often subjected to most clerical errors. According to statistics, it is assumed that the insurance industry is estimated to lose a staggering $80 billion annually in the U.S. alone to cases of fraud. (the Coalition Against Insurance Fraud data states). Knowing these shocking estimates, the increasingly important value of an accurate, organized and diligent insurance claim processing function should not be underrated.
Here's how AI driven Robotic Process Automation (RPA) deployments can come to help.
● Streamline claim processing
The claim team is a centralized hub to first notice the loss incurred from a customer, verifying coverage plans, assess damages, issue settlement notices, and process all insurance payments. As many of these tasks involve tedious manual processes like typing and data entries. Claim information submission through multiple channels such as email, phone, or other online forms is mostly entered by hand into the insurance claims system.
A claims manager usually copies data into the integrated computer systems. The claim is further validated against the policy administration system for assessing all coverage details, then auto-adjusted to assess the settlement amount, and lastly reviewed for fraud detection. Once everything is completed the final payment can be successfully processed.
RPA streamlines insurance claims processing making it easier, ensuring these mundane steps move much faster. A claim adjuster automating extraction and transmission of data can deploy a simple software robot — or a machine learning-enabled IQ Bot to extract and organize unstructured data.
As RPA setup is generally adopted throughout an insurance company, it helps empower employees for better engagement and aids in performing some meaningful much quicker work than paper pushing. Increasing productivity with bots bringing in some organic structure to the vast amounts of claims information and data going through the departments, helping live agents better serve each customer.
● Deploying RPA in insurance
The added benefits of deploying a RPA applies equally to all insurance companies, however some of the ways RPA is used varies by the industry segment. As different bots can be automated or combined in multiple ways to perform highly complex tasks, helping in freeing claims professionals to concentrate on the claims where they can add most value.
RPAs can also be heavily focused on assessing all the damage estimates for a given claim. As the information is extracted from multiple paper-based or PDF forms an IQ Bot can be autotrained to accurately gather the relevant data and information from each such document.
As the claim information is organized, RPA and artificial intelligence (AI) can be combined as an intelligent automation set-up to further analyze the data and detect any fraudulent activities in real-time. Once a claim is screened and found to be low risk, it is authorized for either an immediate payout or, triaged to an adjuster. If a high-risk claim is identified, it is transferred directly to a special investigation unit for further review.
Claim settlement is a single department within an insurance organization. Once RPA automation in insurance is further deployed and expanded across other domains such as underwriting and customer support, it can help in significantly opening up opportunities for additional arenas of business enhancement for most insurance providers.
Whether collecting claim information, or enabling data distribution among systems, managing the process workflow, or investigating fraudulent activities, RPA automation can definitely help organizations maximize their revenues and future potentials.
Given the added advantages of hiring human capacity in terms of innovation, creativity, empathy, and insight, the idea of employing workers to manually move data between systems for hours on end isn’t the best use of their time and skills. Especially when considering that healthcare providers are ultimately focused on improving health, lowering costs, and providing better patient care among others.
By automating claims processing tasks perfect for a RPA. Most clinics and providers can further dedicate human talent for much better tasks such as involving value addition. Ensuring that employee satisfaction and productivity are also likely to be higher as a result.
● Providers can exponentially upscale their services.
Since most manual tasks like claims processing consume approximately 30% of the key staff members’ time. Whereas automated claims processing can help organizations keep up the pace needed with rapid growth: As RPA bots can scale up at over 35% growth year-over-year. Furthermore, freeing up team members to focus on higher-value responsibilities . Adding on bots, the number of claims a provider can process is unlimited.
● Overcoming limitations
As the bounds of limitations to upscaling medical services usually winds up being limitations in terms of human resource capacity for providing a superlative and quality care to each individual.
● The ROI is highly substantial and is mostly sustained.
The initial investment in developing, deploying, and purchasing a bot license for automating the claims processing is lucrative and well worth the returns when envisioning long term gains.
Parting Thoughts
Firstly, each of the benefits listed here impacts insurance companies ROIs and the bottom line—faster and accurate claims processing results in successful payments, without needing to backtrack and correct errors or create a data backlog. An increased human productivity ensures that an employee wages yield higher returns and the resultant work retention is greater than usual. With the added potential for scalability via automation in claims processing, a higher claim volume is always a more lucrative prospect.
Finally, RPA surely offers some long lasting values. As a bot is “trained,” it’s set up to work in the long haul, rather than hiring new employees requiring onboarding KTs to be introduced to the inner workings of a complicated insurance process.
As technology continues to advance, many industries are adopting automation solutions to streamline processes, improve efficiency, and enhance customer experience. The healthcare insurance sector can greatly benefit from such automation, particularly in the realm of claim calls.
Automating healthcare insurance claim calls offers several advantages, including:
Improved Efficiency: With automation, claim calls can be handled more swiftly and accurately, reducing the need for manual data entry and eliminating potential human errors. This allows your organization to process claims more efficiently, resulting in faster reimbursements for customers and reduced administrative overhead.
Enhanced Customer Experience: Automated systems can provide consistent and personalized responses to customers, ensuring that each claimant receives the attention they deserve. By leveraging natural language processing and speech recognition technologies, automated systems can understand customer queries, offer relevant information, and provide real-time updates on claim statuses. This not only reduces customer frustration but also improves overall satisfaction and loyalty.
Cost Savings: Automating claim calls can significantly reduce operational costs associated with staffing and training customer service representatives. By implementing an automated system, your organization can handle a higher volume of calls with fewer resources, leading to substantial cost savings in the long run.
24/7 Availability: Automated systems can be available round-the-clock, providing immediate assistance to claimants at any time. This ensures that customers can access support and information even outside regular business hours, improving accessibility and convenience.
Data Insights: By automating claim calls, your organization can gather valuable data on customer interactions, preferences, and common issues. This data can be analyzed to identify trends, improve processes, and refine customer service strategies. Ultimately, it empowers your organization to make data-driven decisions and deliver better service to claimants.
While implementing automated claim call systems, it's important to ensure a seamless integration with existing customer service channels, such as live agents and online platforms. A well-designed system should offer options for customers to connect with a live representative when necessary, providing a balanced approach between automation and human assistance.
In conclusion, automating healthcare insurance claim calls presents numerous advantages, including improved efficiency, enhanced customer experience, cost savings, round-the-clock availability, and valuable data insights. By embracing automation, your organization can optimize claim processing, reduce administrative burdens, and ultimately provide better service to your valued customers.
