Reducing Claim Costs by Modernizing Claims Business Processes

By James DeRosa | September 26, 2014

The claims management workflow is continuously being improved to increase employee and customer satisfaction, reduce labor/time intensive tasks and claim costs. Driving technology into the center of these process improvements has shown to have a major impact on streamlining the claims process.

Carriers Strive to Improve Claims Technology

The growing demand for advanced reporting and a fluid claim processing system has increased the need for claim professionals to forego the more traditional approach of spreadsheets. The claim life cycle has been more extensive and robust and now shines a light on an antiquated process that claim departments need to tackle.

A few items to take a close look at are:

  • What type of documentation is needed for each claim?
  • What information or documents are constantly utilized and moved from one document to the next that can become an automated process?
  • Define each process and breakdown your workflow. Even though this may be a bit more tedious to complete, the more specific the better.
  • Gather all employees who contribute to the workflow chain to get feedback and input on ways to make a more effective process.

Your goal is to make a workflow process that is intuitive, responsive and flexible. As you map out your claim adjudication process you will see tasks pop up that are sheer repetition and can be automated to decrease time intensive items. Start with your obvious low hanging fruit to analyze patterns.

The changing landscape in the insurance industry with ‘big data’ taking the driver seat in claim departments puts a spotlight on inaccurate facts and figures due to manual human error. Your claims system should give you the confidence to create a robust report and analyze the facts thoroughly with each new claim. Tasks such as reviewing claims, adding in notes and documents and sending payments should be in an intuitive workflow.

Modernizing claims system business processes will be a big undertaking, however the return on your investment will be rewarding. As changes are put in place make sure to schedule milestones every 30 days to gauge if a new processes is working. Insurers are now going full speed to reduce claim costs and with the rapid change both in claims and risks faced, updates to business processes have become important to make effective decisions. Work closely with your claims management software vendor to research and develop the best business rules that create a proactive work environment. The end result should be a flexible claims technology solution for both your adjusters and customers.

What recent business processes has your claims department updated recently?

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About James DeRosa

James DeRosa the founder/CEO of JDi Data Corporation, has successfully developed innovative technology software solutions for company growth and client satisfaction in the insurance industry for carriers, risk managers, third party administrators and public entities. Learn more at More from James DeRosa

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