A never-ending stream of claims is daunting. Especially when they involve health insurance or workers’ compensation because the insurer knows there are people behind those claims with timely issues like surgery or urgent treatments.
Insurance companies are responsible for data accuracy, reliability, and privacy when meeting client commitments.
Claims processing goes through multiple layers of administrative, managerial, and functional processes, and information is exchanged in various formats.
Automations are solutions that tech provides to claims managers and insurance carriers. Automations allow the manager or person in charge to execute a series of actions, communications, or processes under parameters they set up.
For example, a claim has been resolved and involves getting surgery from a health provider designated by the carrier. Let’s suppose there’s automation set up for this scenario. Once the claim is solved, a communication is sent to the claimant and/or policyholder, along with the medical provider that is supposed to attend to their claim.
In this case, the communication would be sent with no intervention of the adjuster other than its first setup. Automation, therefore, relieves duties and saves insurers time.
There are many benefits to having automation available in your Risk Management Information System. We will explore some benefits in this article while going deeper into what automation can do.
How Does Automation Work?
There are 3 types of automation available in RMIS for Insurance Carriers
1.Artificial Intelligence (AI)
AI technology is becoming commonplace when it comes to insurance claims processing. AI makes it possible to extract data, analyze it, and make recommendations
2.Robotic Process Automation (RPA)
Robotic Process Automation automatically extracts data from insurance documents. It reduces the need for manual data entry, does membership/validation checks, and improves the adjudication process by streamlining application reviews.
3.Intelligent Process Automation (IPA)
Intelligent Process Automation is used to reduce operating costs. Many insurers spend vast amounts of time organizing, structuring, and reviewing data. Intelligent Process Automation collects insights from documents and creates machine-learning models with algorithms that read documents just like humans do. IPA in insurance can automate most of the work and applies rule-based data extraction techniques. Where rules don’t apply, claims automation AI and IPA can help users read data intelligently, and the technology can interpret a variety of data formats. IPA is also used for underwriting, claims processing, new customer applications, and generating reports with photos.
Benefits of Automation for Claims
1.No more manual tasks
Manual tasks consume a significant amount of time that is no longer necessary to spend. Technology gives insurers the time to think about the bigger picture by handling data collection, internal and external communications, categorization of information, and even underwriting.
By implementing automation, insurers set up parameters, like date and time, triggers, and the action to be taken. Once those triggers appear on the time range, date range, or both, the automation will put the effort in place.
Let’s say sending an expiration reminder message to the insured will be executed with no further intervention, no need to approve manually. Once the insurer has given clear and tight parameters, no further time investment is needed.
2.Checking compliance
Another parameter to set automation around is compliance. Automations for compliance check the compliance status based on a group of requirements. These requirements often change. Keeping up with these changes can be difficult. Even worse, they can result in litigation if compliance requirements are not correctly followed.
Automation for Compliance checks potentially ends the possibility for litigation because they are constantly in the works to update and recheck that everything meets requirements and is in compliance.
3.Benchmarking
Benchmarking via automation gets insights and comprehensive reports of how everything and everyone is performing on each claim, the claims that take longer, the type of claim that’s more expensive, and so on. Automated benchmarking helps insurers by constantly updating them on where to improve and creating accountability for those improvements.
4. Faster Decisions
Automating parts of the process leaves a better and more comprehensive picture of your claims environment. Having a clear vision allows decision-makers to make up their minds more efficiently. More importantly, make informed decisions supported by data, data that was provided by a unified risk management system, collected by automation, and served in an easy-to-grasp report.
5. Better Service
Enhanced comprehension of the claims management process will allow insurers to focus and improve where necessary. Claims take too much time. If communications are answered or sent in a timely fashion, or if claims are not solved with the efficiency they demand, clients will require better service.
Automations can pull information together, make reports, teach the insurers where to improve, and give the clients the improved service they need. Plus, these are the same automation that can handle communication and management of claims. So not only will they show insurers where the pain points are, but they will also help to relieve the pain.
6. Fewer costs (and less litigation)
All these benefits surrounding automation lead to one supreme enhancement: back-to-back cost reductions. It’s simple, by working more efficiently and reducing the time it takes to solve a claim, clients will be much happier and less prone to litigation over a disputed claim.
Also, by knowing where to improve the process as it is, insurers enhance claim processing further, generating a feedback loop that ensures everyone is doing what they are supposed to be doing and being the most efficient at it.
Opening Opportunities Via Automation
Automating the claims management process is a critical best practice in the insurance industry. When working on claims, time is always the top priority.
By implementing automation, carriers streamline data entry, improve efficiency, enhance service, and remain compliant. This opens the door for endless opportunities to make a real difference in how you handle claims and show your clients that their time is as valuable as yours.
Do you want to have a meeting to discuss Terra, a Risk Management Information System with automation? Meet our team and take a look
