Today’s policyholders expect fast and reliable insurance service tailored to their needs. Claims organizations need to accurately and efficiently manage claims while balancing the growing demand for speed and reliability. However, operational bottlenecks and lack of business agility continue to delay claims resolutions and increase costs. Leading insurance companies are turning to process automation to improve customer satisfaction and employee experience.
Why claims process automation matters
One of PwC UK’s insurance clients was handling complex claims related to employer liability. Claimants suffered from long-term, work-related illnesses. Claim handlers struggled with non-integrated systems and inefficient processes, such as manual processing of paper-based records. This resulted in costly errors, poor customer satisfaction and a delay in providing claimants the compensation they desperately needed.
The insurer recognized that these process issues were rendering it incapable of running its business effectively and asked PwC to take over the day-to-day claims processing workflows.
PwC worked with Appian to develop the right solution for the client to streamline and automate the claims handling process.
Ultimately, PwC increased claim handling efficiency by 30%, providing faster compensation to workers. They were able to reduce claims processing time for complex claims, enabling workers with work-related illnesses to get the care they need in a timely manner.
Automation is not just about speed—it’s about striking the right balance between efficiency and delivering a human touch. Insurance companies that use claims processing automation can:
Reduce operational costs and claims leakage.
Improve straight-through processing rates.
Speed up the steps in claims processing.
Deliver superior customer service with more transparency.
Reduce the risk of fraudulent claims.
Claims automation in action
The power of connected claims
Insurance process automation solutions like Appian Connected Claims use advanced technologies to make claims management processes better. Here’s how:
1. Unify disparate data for faster claim assessments
Disconnected systems are a major bottleneck in claims processing time. Using data fabric technnology—an integrated data layer that connects data across your enterprise, insurers can:
Bring together information from claims systems, CRMs, policy administration tools, and advanced data sources.
Gain a single-pane-of-glass view for every claim, enabling faster and more accurate assessments.
2. Optimize claims handling with automation
Manual processes in claims intake and verification sabotage efficiency. Process automation tools can help:
Optical character recognition (OCR) and natural language processing to quickly capture data from claim forms and medical records—without the risk of human error.
Robotic process automation (RPA) to drive straight-through processing, automating repetitive tasks to reduce manual interventions.
3. Enhance the customer experience
Customers expect touchless claims experiences. Automated systems allow insurers to:
Offer multi-channel loss reporting options.
Provide real-time access to claims status, enhancing transparency and trust.
Let policyholders self-service with chatbots that don’t require human intervention.
4. Improve fraud detection and management
Fraudulent claim submissions are a significant risk for insurers. Connected Claims helps avoid potential fraud by:
Creating a unified view of potential fraud alerts.
Giving Special Investigation Units (SIUs) full control of fraud case management.
Lowering the risk of error to reduce false positives.
5. Make more data-driven decisions with AI
Intelligent automation plays a critical role in modern claims management. By embedding artificial intelligence into claims automation, insurers can:
Analyze claim forms and medical records and quickly and accurately extract relevant data from them.
Support decision-making for claims adjusters by generating recommendations for next best actions based on data.
Stay compliant with regulatory requirements with private AI technology that keeps confidential data under your control.
With automated claims processing, insurers can meet the evolving needs of their customers and see better operational efficiency. Claims process automation is crucial for staying competitive in today’s insurance market.
