Products & Services. The industry’s most comprehensive claims solution, iVOS manages the full range of insurance transactions, including claims,
policy administration, underwriting, billing, medical cost containment, event management and document imaging. iVOS is highly configurable and fully customizable
for all lines of insurance, including workers’ compensation, general liability, property, auto, professional liability and disability.
Increase Your Claims Velocity
The claims industry must respond to market pressures to automate and
accelerate claims processing. Using Web-based technology, organizations can
streamline traditional inefficiencies and reduce manual, paper-based processes,
which have contributed to inefficiency and high administrative expenses. In this
article, we outline seven strategies that drive increased claims velocity.
1. A Browser Revolution
An organization’s unique claims management strategy is the cornerstone
of its competitive advantage. In the past, policies and procedures were
hard-coded into claim systems. Changing a process meant retooling the
software—a task that required a programmer to perform. With today’s rapidly
changing claims environment, organizations need to respond quickly, without
waiting for IT assistance. To adapt to market fluctuations, organizations are
demanding browser-based systems that enable business users to implement
process changes on their own and on the fly. They must have the ability
to continually rethink processes and, where appropriate, redesign claims
workflow for optimal efficiency. A high-velocity solution provides both robust
claims functionality and powerful customization capabilities out of the box.
2. Prompt Claims Reporting
Prompt and accurate reporting of claims is critical to achieving the best-possible outcomes. With the advent of intelligent online claim forms, the
use of Internet reporting is dramatically increasing. These smart forms
use drop-down lists, auto-populated fields and threads of logic to navigate
users quickly through the electronic claims submission process. Due to its
intuitive design, online forms are faster than a typical phone transaction.
Beyond speed, web-based transactions provide significant savings. Using a
call center, the injury reporting process can cost an average $16 per claim,
but Web-based reporting reduces the cost to $3 per claim.
3. A Paperless, Data-Driven Strategy
Today, the vision of paperless claims processing is finally being realized. In its
rudimentary stage, organizations scanned documents but continued to use paper
to exchange information via fax and mail, as well as to store documentation.
To engage in a truly paperless paradigm, organizations are now avoiding the
generation of paper documents, relying instead on the electronic submission
and exchange of information. In this data-driven environment, information is
input once and made available to all parties via an enterprise platform. The
paperless paradigm continues to expand as organizations incorporate optical
character recognition (OCR) and attach digital photos, videos and audio to
electronic claim files. This data-driven environment yields more information for
real-time analysis, benchmarking and performance reports.
By Monte Dalton
Regional Vice President,
4. Business Rules Enable Straight-through Processing
Ideally, insurance companies want to apply adjuster resources where
they are needed most. By leveraging a business rule engine, organizations
increase their rate of straight-through processing. Organizations customize
business rules to review incoming claims and identify the “simple,
straightforward” transactions that can be routed for immediate settlement
and closure with little or no human intervention. Business rules ensure
consistent quality in an automated claims-handling environment, while also
enabling adjusters to focus their time and attention on more complex claims
that require their expertise.
5. The Adjusters’ Automation Toolkit
Adjusters can utilize automation tools—such as automated forms,
sophisticated diary systems, scheduling tools, streamlined communication
and “smart” prioritization of tasks—to help coordinate routine administrative
functions, saving as much as 20 percent in adjuster time and resources.
Advanced automation enables adjusters to focus on the tasks that directly
impact costs and outcomes. Within this toolkit, letter-writing and form-generation
templates automatically produce documents with fields auto-populated from
the claims database.
6. Hyperlink Technology
Today, consumers are accustomed to the use of hyperlinks in e-commerce
transactions, and hyperlinks are increasingly being used to streamline
claims workflow. Within the claims industry, a “guest link” is basically a
hyperlink sent via email. It allows an external user or “guest” to directly
access a specific claim. The hyperlink is secure, and access rights are
defined by the sender (usually the adjuster) as “view only” or to allow the
guest to add information that is updated in real time. The guest link provides
organizations with transactional costs savings and cuts back on bottlenecks
in exchanging information, such as waiting for returned calls or faxing paper
files to other stakeholders.
7. Quality Control through Online Audits
Because audits are time-consuming, they were typically performed only
on a retrospective sampling of 10 to 20 percent of claims. Today, online
auditing has allowed the process to become more electronic and transparent.
Organizations now perform real-time concurrent reviews of 100 percent of
claims, enabling them to ensure a higher level of claims-handling performance.
Audit findings allow claims managers and adjusters to fine-tune operations,
achieve a tighter lifecycle and ensure cost-containment at key junctures of the
claims process. n