The holy grail of an insurance business is the ability to efficiently and accurately process claims. In this customer experience era, reaching that ‘Promised Land’ of customer loyalty and customer delight for insurers, like you, ultimately boils down to how swiftly and accurately you achieve claims settlement.

To reach there, you must bid adieu to the conventional ways of processing claims and approach the overall process in a diligent manner and find the right technology for your claims automation software.

Having said that, the question is how do you find an ideal solution for your organization. To help you choose the best-fit software solution, let’s look into nine key things that must be taken into consideration.


1. Enables automation of the end-to-end claims process:

You should look for a low code-based software that facilitates integration with new-age technologies, including analytics, artificial intelligence (AI), machine learning (ML) , and robotic process automation (RPA) to automate the end-to-end journey of insurance claims. Leveraging AI/ML and RPA-enabled software can help you automate the the most mundane yet complex claims processes, from receiving an application request through any channel, assigning it to the claims admin, routing, case adjudicators, to finally settlement.


2. Facilitates document digitization and multi-channel content support:

You must seek a claims automation software with content management capability to efficiently manage a high influx of claims documents. The software must facilitate the initiation of content from multiple channels, including physical, e-mail, website, social, etc. Furthermore, for the easy access and retrieval of the policy details by the user, the content must be available on a centralized repository

Insurance Claims Automation Software

3. Permits smart case routing and allocation:

Your insurance claims automation software must have rule-based algorithms that allows you to automatically categorize claims as “fast track” or “non-fast track.” Additionally, the software should be able to auto-prioritize cases at different queues and work steps and, depending on the rules, automatically route claims based on the adjudicator’s workload and prior experience in handling complex cases


4. Provides customer self-service portal:

Your customers must have the flexibility to submit claims in real-time and track their progress at each stage of the process. Thus, a claims automation software should support a customer self-service portal that can be accessed via a mobile and web-enabled application


Claims automation

5. Performs comprehensive claims assessment:

The software should be able to do a complete evaluation of each claim by giving the assessor an all-inclusive dashboard. It should be able to auto-identify claim type based on policy data and auto-assess claim details against the stated plan and coverage details, claimant details, and other system check outputs. Furthermore, the software should have an option to define alternative rule sets for auto-calculating the authorized amount and co-payment based on claim submission parameters


6. Provides insights and close monitoring capability:

The ability of claims automation software to actively monitor cases and give detailed insights to ensure tight adherence to turnaround times (TATs) and service level agreements (SLAs) is one of its most critical qualities. Therefore, the claims automation software should define key performance indicators (KPIs) to monitor and measure user efficiency, an escalation matrix and monitoring reports to ensure transparent, and timely claims processing, payments tracking, user productivity and workload reports, raise fraud alerts in the event of discrepancies, and more


7. Enables customer communication support:

Timely communication with customers is important so that the knowledge workers are aware of the status of their claims at any stage. Furthermore, at any relevant stage of the business, the claims automation software must enable users to auto-trigger communications to customers, third parties, agents, distributors, and relevant employees via texts or emails. This includes the generation of letters of guarantee, case summaries, settlement letters, and more


8. Enables robust integration architecture:

The solution should seamlessly connect with existing systems and databases, such as the Core PAS system, accounting system, mobile app, e-mail and SMS gateways, and CRM. This allows you to make the most of your existing technology investments while also providing smooth information flow throughout the claims department


9. Enables seamless collaboration between stakeholders:

The claims automation software should make it easier for all the involved stakeholders to minimize the processing cycle times. The claims assessor should be able to simultaneously refer the case to different internal/external teams for assessment and comment. The concurrent execution of various operations on the case speeds up the processing cycle. The assessor can then quickly determine whether to approve, refuse, close, mark as pending, or forward the case to other teams within the claims platform


In a Nutshell

The above considerations will help you select the right technology solution for streamlining end-to-end claims processing cycle. In terms of functionality, you must invest in a comprehensive solution with an automated workflow-based claims process that allows your documents and data to move in tandem, offers enterprise-wide visibility and reporting, and enhances seamless collaboration among stakeholders.

Read this brochure to learn how you can implement a comprehensive platform-based solution to transform the claims process and reap benefits in three fundamental areas–operational efficiency, impact on business, and customer satisfaction.