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How to effectively and (carefully) automate claims and reduce cost.

How to effectively (and carefully) automate claims and reduce cost.

Communicating with customers exactly when and how they prefer is crucial in creating a positive experience. While high-efficiency, technology-based solutions work in many cases; there are situations where human interaction can produce better outcomes.

The 10,000-foot View

Reducing costs and optimizing workflows have long been a priority for claims organizations. Some have achieved this by automating tasks and workflows, increasing efficiency and accuracy. Automation also offers benefits such as faster settlement timelines and improved process transparency, which are critical for customer satisfaction. However, claims leaders are now wondering what the next step should be beyond automation. Technology alone cannot solve everything; efficiency is just one aspect of claims performance.

As straight-through processing becomes more common, insurers question whether completely removing human interaction could be risky for customer satisfaction. In cases where events have a high emotional impact, such as clinic visits, hospital procedures, property damage, or an injury or accident, the personal touch can be precious. While most claims can be handled without human interaction, insurers should take advantage of the opportunity to provide highly-personalized or customized services to customers who may only sometimes require it.

Finding the right balance between automation and personalization to optimize claims performance and provide the best customer experience is something you want to spend time doing.

Map it Out.

To design a seamless customer experience and optimize claims performance, it's essential first to understand what customers want. Customer journey maps can offer valuable insights into the various touchpoints and activities involved in the claims process. It's common for insurers to discover a lot of variabilities when inventorying the many paths a claim can take to resolve. However, despite unique ways, there are often shared sub-processes and tasks to automate with a few different technologies.

To gain visibility into customer journeys, insurers can use robust analytical and process mining tools to capture digital footprints and produce visual maps. The real value of customer journey mapping lies in identifying areas where standardization and automation can have the most significant impact, as well as opportunities to delight clients and increase engagement and loyalty. Timely and proactive status alerts are one such opportunity, while high-risk areas that may cause process breakdowns can also be identified.

Insurers can build trust by anticipating which claims will likely lead to service failures and taking proactive steps to keep them on track. This is particularly important for insurers seeking to use customer data in new ways, such as data streams from homes, vehicles, and workplaces. In the future, mobile apps and smart tech can use sensor data to initiate claims or alert consumers and business owners to necessary repairs or maintenance, creating opportunities for risk prevention. To succeed, insurers must educate consumers about these capabilities and their benefits.

Pilot It.

Optimizing claims performance is essential to improve customer experience and reduce costs for insurers. However, it's critical to approach this process carefully to ensure the best results. Optimizing claims performance in a revenue cycle before automating the entire process can provide numerous benefits.

Firstly, piloting allows insurers to test different solutions and analyze their effectiveness in a controlled environment. It provides an opportunity to identify potential issues and limitations of the optimization process, which can be addressed before deploying the solution across the entire system. This approach can minimize risks associated with implementing new strategies and reduce the likelihood of errors that could impact customers and operations.

Secondly, piloting allows for assessing the organization's readiness for changes in processes and technology. It will enable insurers to determine whether their current infrastructure can support the optimization process and whether staff members have the necessary skills and knowledge to adapt to the new system. This assessment can inform future training and development programs to ensure staff members are prepared to transition to the new process.

Finally, piloting the optimization of claims performance in a revenue cycle can provide valuable insights into how the process can be further improved. It allows insurers to gather feedback from stakeholders and customers, knowing when and where bots or humans should take over and inform future process iterations. This approach ensures that insurers can continuously enhance their claims performance optimization process, leading to better outcomes for the company and its customers.

Find a Co-Pilot to Help You on Your Journey

Once you've decided that automation is a path worth exploring and the right solution for your organization, gather your data. You want to identify every process that can be automated and start creating a map of your entire business process. This will include process steps, data flows, and relationships between departments or teams.

You can start generating ideas to streamline these processes. Try to look at each stage from the perspective of a computer rather than a human. Computers excel at performing repetitive tasks, and that is where bots shine. Once you map the steps in the process, you can assess its impact on your overall efficiency and profitability.

It's essential to start testing any new technology in a sandbox environment. This will allow you to monitor how the software impacts your business without impacting other departments or wasting time and money on unnecessary changes.

It would help if you remembered that while automation is a powerful tool, it could be better. You may still need human oversight to ensure the software operates as it should. And you'll still need regular monitoring to ensure your process is executed as intended. You don't want to put your business at risk by relying exclusively on automation. But when used correctly, automation can help reduce costs and increase productivity in measurable ways.

Published On:

March 1, 2023

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