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Insurance Claims Process Automation: 3 Areas to Automate

Catherine Canary, Appian
October 28, 2024

In the insurance industry, the claims process can often feel like a complex maze of manual processes for both customers and agents. However, new and advanced technologies are paving the way for smoother, more efficient claims handling. Claims processing automation at insurance companies can streamline routine tasks, reduce risk of errors, and enhance customer satisfaction. In this blog, we’ll explore three key areas to focus on for effective automation.

1. Claims submission and triage

The initial stages of the claims process can be cumbersome, involving lots of paperwork and lengthy phone calls. Automating claims submission and triage can significantly improve efficiency and lower risk of errors.

Benefits of automating claims submission

  • Online portals: By providing customers with an online platform to submit claims, insurers can reduce the time spent on manual data entry and improve accessibility. 
  • Mobile apps: Allowing customers to submit claims via a mobile app enables instant reporting, making the process more convenient.
  • Document uploads: Customers can upload unstructured documents directly through the portal, which streamlines data collection and improves processing times.

Triage automation

  • Automated sorting: Use process automation platforms to categorize claims based on urgency and complexity. This allows for quicker routing to the appropriate team and decreases reliance on manual tasks.

  • Initial assessment: Implement AI-driven tools like intelligent document processing to perform an initial assessment of claims, identifying potentially fraudulent claims and prioritizing legitimate claims for faster processing.

By automating these initial steps, insurers can significantly improve operational efficiency by reducing the time from claim submission to acknowledgment, leading to shorter processing times and a better customer experience. It can also improve identification of fraudulent claims.

2. Claims processing and review

Once a claim is submitted, the processing phase can be time-consuming. Automating this stage can lead to quicker resolutions and more accurate outcomes.

Streamlining claims processing

  • Robotic process automation (RPA): Use robotic process automation to handle repetitive tasks like data entry, verification, and status updates. This minimizes human error and frees up adjusters to focus on complex cases.
  • AI-powered analysis: Implement artificial intelligence with natural language processing to analyze claims data (even in unstructured documents), identify patterns, and suggest resolutions. This can speed up decision-making and enhance the accuracy of claim assessments. It can also support bots in handling complex tasks.

Workflow automation

  • Integrated systems: A data fabric approach can unify various data sources and systems, ensuring that all relevant information is accessible in one place. This integration helps streamline communication among teams.

  • Automated notifications: Set up automated notifications for both customers and agents regarding the status of claims, reducing the need for follow-up calls and increasing transparency.

By automating the processing claims phase, insurers can significantly improve turnaround times and customer satisfaction.

3. Claims settlement and payments

The final step in the claims process—settlement and payment—can also benefit greatly from automation. Efficiently managing this phase can enhance trust and loyalty among customers.

Automated claims settlement

  • Pre-approved payments: Use AI algorithms to identify claims that meet certain criteria for automatic approval. This reduces the time needed for manual review and speeds up payment processing.

  • Dynamic payment systems: Implement automated payment systems that can instantly transfer funds to customers once claims are approved, improving overall satisfaction.

Customer communication

  • Real-time updates: Intelligent automation can facilitate real-time updates for customers regarding payment status. This transparency helps build trust, reduces anxiety, and provides valuable insights.

  • Feedback mechanisms: After settlement, automated surveys can gather customer feedback, helping insurers continuously improve their processes.

By automating the settlement and payment processes, insurers not only speed up transactions but also enhance the overall customer experience.

A platform approach to insurance claims process automation

Moving from manual processing to insurance claims process automation is not just a trend; it’s becoming a necessity in today’s competitive market. By focusing on automating claims submission and triage, claims processing and review, and claims settlement and payments, insurance companies can significantly improve operational efficiency and customer service results. 

Using a process automation platform with robotic process automation, AI, and a data fabric approach will give you the best return on investment, saving operational costs. Automation platforms streamline operations and data management all in one place. As the insurance industry continues to evolve, embracing automation will be crucial for staying ahead and meeting the expectations of tech-savvy consumers. Investing in these technologies now will lead to lasting benefits, both for insurers and their customers.

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