The current insurance claims management framework is a multi-tiered process. Every claim has to go through a number of steps of verification, evaluation, validation and settlement. This slows down the process and impacts customer experience in manifold ways.

The primary reason for this inefficiency is over reliance on manual and legacy system. Even carriers who have made a shift to tech driven processes have not been able to overcome the challenge completely. This is because, advanced technologies do not integrate seamlessly with legacy environment. And overhauling the system end-to-end is a costly proposition.

Therefore, the current insurance claims management framework needs a major rejig on many fronts. In this article, we will explore 5 top ways to make this happen.

5 Ways to Improve Insurance Claims Management

Here’s throwing light on 5 smart ways to improve insurance claims management:

Human Intelligence Empowered by Digital Technologies

Technology cannot replace nuanced human decision to settle complex claims. However, it can ease and accelerate the decision-making process. Here’s how:

  • Advanced analytics swiftly categorizes each claim based on their complexity. The claims are then routed to agents with the required expertise. AI-powered cognitive agents handle simple claims. This takes off the burden from human claim handlers. It allows human agents to focus on settling complex claims.
  • Cognitive whisper agents relay relevant information to complex claim handlers through analytics-enabled dashboards. It is key in assisting handlers to swiftly determine claim outcomes. Based on this claim outcome determination, handlers work on the next best steps.
  • Medical treatment analytics tips off claim handlers on instances where a worker’s compensation claimant did not actually perform a particular treatment but had claimed for its compensation. Based on this tip, handlers contact the claimant and notice the policyholder.

Proactive Communication with Customers

Proactive communication to customers is a key to reduce redundant incoming calls to insurance claims call centers. It frees up agents to focus on handling other complex claims-related queries. Proactive communication is also essential to build the bond of trust with customers. It is because such a proactive communication can reduce chances of damages. This will eliminate the need for customers to file for loss claims in the first place. Here’s how insurers can do it:

  • Claims department can use an omnichannel communication medium to relay automotive repair status updates to customers with an automobile insurance policy.
  • Insurers can create an online claim portal that will contain images and videos of property insured by a policyholder. He/she can visit this portal to know which portions will require immediate repairs. Accordingly, they get in touch with emergency mitigation services department.

Data to Unite Siloed Insurance Departments

Most of the insurance organizations have departments with separate data repositories. Such separate databases create siloed data. This gives a major headache to claim administrators. They find it extremely difficult to accumulate the necessary data across multiple departments and make meaning out of it. The result is significant delays in claim settlement or claim disputes. This puts off customers who, on a heartbeat, goes shopping elsewhere. Here’s looking at ways by which data can actually be used to bring together siloed departments:

  • Insurers must use business intelligence dashboards. This digital tool accumulates data from multiple departments, analyze it, and creates graphical illustration of data insights that is easier for even a layman to understand. The data seamlessly flows through the stages of information collection, underwriting, policy administration, and claims settlement. Claim adjusters can easily access this data at any point of time. This is instrumental in reducing cost, complexity, and errors during settling claims.
  • Financial summary dashboard makes it for claim adjusters to manage all financial transactions within a single portal. It allows to track in-process claims, claimant document status, and activity history. They can set up claims line items based on categories such as payees, associated coverages, inputs, and approval/denial reason codes. Such data dashboards are enabled with a drag and drop interface that makes it easy to upload documents. It can also be programmed to send alerts to claim adjusters on any outstanding requirements.

Better Fraudulent Claims Detection

An overload of claims settlement requests can lead to costly mistakes. One such oversight is failure to distinguish between genuine and fraudulent claims. This can cost a major chunk of insurers’ annual revenue. While large insurance companies may have the bandwidth to absorb the losses, it has major financial implications for small and medium scale insurers. Here’s how, insurers can contain fraudulent claims approval:

  • Data analytics tools analyze a suspected fraudster’s past claims history, the type, and history. If the pattern does not fit the required standard, the claim is flagged. Fraudsters file for low-valued claims. They expect that since it is small amount it will go unnoticed. Advanced analytics based on machine learning techniques such as cluster analysis can detect such small fraudulent claim amounts.
  • Fraudulent claims investigators must look out for suspicious loss indicators. This is a list of 23 items created by the National Insurance Crime Bureau that indicate fake claims. For instance, handwritten repair receipts can be potentially fake. Medical claim submitted by an employee who has reached the end of his/her tenure should be flagged.

Ability of Claims Professionals to Handle Technologies

Artificial intelligence- driven claims administration process can expedite the process of claims settlement. But it will be of little use if your claims administrator fails to use it optimally. As a matter of fact, technology is not meant to replace human intelligence. Rather, it is supposed to augment it. Insurers can achieve such an ideal scenario by hiring claims professionals who have the following abilities:

  • Requisite skills and training to make the best use of automated results generated by digital technologies.
  • Quickly choose the best tool and data to process a specific claim.
  • Know when to switch from automation to human engagement based on complexity of claims.

How We Assist You to Improve Insurance Claims Management?

Insurance claims management is plagued by siloed workflows. Even veteran insurance carriers are no exception to this. We leverage our highly skilled professional, well-defined process flows, and advanced technologies to break through these siloes. It allows us to execute all the back-office claims administration tasks effectively.

We create a simpler business model to execute complex and siloed claims processing tasks. Our experts break down the entire process into smaller task units. Professionals are assigned to manage each unit. They use analytics tools to get a 360-degree overview of all the unit operations in real-time. Such an overview allows us to re-assign resources based on dynamic work volumes. We automate low value but mandatory tasks to increase resource productivity.

Our effective verification services tally coverage details provided by policyholders with that of insurers. This is particularly helpful when a person fails to update certain information in the claim files. It aids your claim adjusters to expedite the process of settling claims. Such a fast claim approval is critical in building your relationship with customers.

We leverage cutting-edge data analytics tools that identifies fraudulent claims. Our team of experts organize and execute claims fraud investigation activities. These activities include doing a background check of the claimant, his/her personal information, creditworthiness, among others.

Who Are We and Why Are We Considered as an Industry Authority?

This article is penned by authors at Insurance Backoffice Pro, a prominent insurance claims administration services provider. Our services include policy information verification, coverage and liability amounts verification, fraud investigation, among others.

Get in touch with us if you wish to streamline your claims insurance administration workflows.