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Over the last 9 months, there has been a drastic shift in the way businesses function and this phenomenon is seen across the globe. Insurance companies are no exception, enterprises that were performers over the last few years are now looking at digital adoption and solutions to transform their business, including efficiency, optimising resources, and enhanced customer experience.
The one functionality that plays a crucial role in the insurance business is “claims”. This is the one that can make or break a business. Across insurance companies, claims management is a sensitive area that companies are hoping to streamline and ease up. There are instances of undue delay in verification of the claims request, authentication of the supporting documents provided, and other elements that lead to losing customers, subsequently leading to loss of business as well.
The objective of insurers across the spectrum is to increase efficiency, boost the speed of claims processes, and heighten customer satisfaction levels, which will lead to business growth. The need of the hour, therefore, is seamless claims processing which addresses all the challenges mentioned above. We have done a few blog posts earlier on automating the document process flow, Intelligent Document Processing [IDP], and why insurance enterprises need to adopt IDP. In this post, we shall focus on the healthcare space, with a specific focus on claims.
Intelligent Process Automation in Insurance
Considering the volatile scenario looming large, healthcare organizations are prioritizing digital transformation initiatives. Insurers are dealing with pressure from competition and the growing demands of customers. One of the main reasons why insurers are facing these challenges is the limitations within the core systems that causes a delay in launching new products, innovation, and offering advanced technological capabilities. Similarly, the need for automation is quite high, as it will help speed up the customer onboarding process, reduce time and cost in claims management, and open doors to new upselling opportunities.
It is vital to deploy automation into the processes as it is the only way to achieve speed to market, constant innovation, accuracy in data, gaining insight into customer’s profiles, and ease up the claims process. Let us look at the four elements involved in offering a seamless claims process to customers are,
Understanding the Current Claims Business Process
Delivering an exceptional experience is the most important objective of the claims process, as that is a critical factor in customer retention. However, insurers are challenged to reduce costs – and for claims organizations – that means optimizing processes is also a top priority. Superior claims management demands speed and accuracy, but claims operations teams are often challenged with juggling multiple systems that contain customer and claims data, slowing the claims process and increasing the possibility for inaccurate decision making, potential fraud or litigation, or losing a customer by not meeting their service expectations.
The broad steps in the current claims process flow are:
IDP Solution – Transforming Claims
The process mentioned above is quite detailed, and most of the steps involved a paper trail and therefore the entire claims management process takes time and is quite cumbersome. With an intelligent document processing solution, the entire process is redefined.
Capture: Instead of submitting the paper documents physically or via mail, the customer can scan the relevant documents through a mobile app which can include a variety of document formats – ID cards, lab forms, medical records, claim forms, invoices, discharge summaries, etc.
Recognition & Classification: Being an AI-driven solution, IDP automatically recognises different document types and classifies them into various categories, such as forms, KYC documents, hospital records, etc. Further, the ingested documents use an image pre-processing engine to enhance the quality of the documents and make them ready for data extraction.
Extraction: Based on the document classification, the solution uses an OCR engine to digitise the documents, and built-in pre-trained modules to extract specific and relevant data points from the documents, such as policy number, claimed amount, underlying condition, discharged date, etc.
Validation: The extracted data goes through a series of complex validation rules and AI-driven business rules engine to rule out the possibility of a fraudulent claim and prevent claims leakage. This includes checks such as:
Verification: Based on the confidence threshold limit set by the user, it flags specific documents and data points with irregularities. It escalates and triggers a BPM process to notify the authorised human in the loop for further investigation, reviews and notifies the customer for additional documents for verification.
Integration: Once the data is thoroughly checked and verified at various stages it can be further ingested into an organisation’s core system or other line-of-business systems. Using integration connectors, claim details are further sent to the finance & accounting department for payment processing, and the customer is automatically notified through an email.
Benefits of Automating Health Insurance Claims
For organizations that rely on manual processes, managing medical claim documents and data is labour-intensive and error-prone. In medical claims processing, intelligent document automation can increase efficiency and accuracy, minimise touchpoints, and eliminate process bottlenecks. Some of the key benefits of implementing IDP in health insurance claims are:
Digitizing the entire claims processing and settlement will enable faster reimbursement and greater customer satisfaction. This will also provide a competitive edge for the company and subsequently facilitate business growth as well.