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February 28, 2022

The Fast Track to Group Insurance Claims Processing

Introduction

What is it about the need for speed? Whether it’s being the first to cross the finish line or racing to catch a train just as it’s about to leave the station, there is something immensely satisfying about being fast and making things happen as a result.

Group insurers, whose customers expect fast claims turnaround, understand this need and expectation. Our most recent Insight (link to “Fast Track Your Claims Processing” needed here) addressed the industry’s demand for accelerated claims processing to stay competitive and to increase profitability. For robust claims management, insurers need such next-generation technologies as:

  • Real-time claims data and analytics,
  • Omnichannel engagement alternatives, and
  • Enhanced workflow management.

Today’s group insurance industry remains highly commoditized, with most insurers competing mainly on price rather than on product differences. Insurers whose technology can expedite the claims process and provide a seamless user experience for all stakeholders will benefit from a significant competitive advantage and adjust faster to the evolving claims landscape.

The Need for Speed: Today’s Claims Expectation

Despite the benefits of a successful business model, insurers have generally lagged other industry segments in embracing core systems transformation, especially claims automation. The ongoing pandemic and significant increase in claims, as well as consumers’ heightened expectations for a personalized customer experience, further exacerbated this gap. Insurers that use claims automation are more efficient and see higher customer satisfaction, especially when that automation incorporates digital technology for virtual or touchless claims handling. Insurers that use digital channels also experience 80% shorter cycle time than those using traditional channels.1

Expedited Claims Processing 101

With today’s ongoing volume of claims, insurers need a core system with powerful and transformative capabilities for auto-adjudication when appropriate, and that can provide a platform where claims handlers can reconcile more complex claims. More automated review via straight-through processing will result in more cost efficiencies, especially due to the decreased need for manual labor and reduced claims overpayment (leakage). Other automated, next-generation tools that can enable rapid, data-driven examination and decision making include:

  • Machine learning-enabled predictive analytics,
  • Hypersensitive dashboards for real-time analytics, and
  • Operational analytics for optimized workflow and continuous improvement.

Insurers also require a core system to provide an intuitive, efficient, and guided experience that provides users with status updates at every stage of the claims journey. For internal users, the ability to leverage member-specific policy data regarding coverage information to eliminate rekeying and costly errors is another imperative, especially during periods of higher claims volume submission.

Final Thoughts

The need for speed is here to stay. Customer expectations around claims processing can attest to that. To stay on the fast track, group insurers need a core system that can provide the tools to enable streamlined processing, advanced workflow methodologies, and analytics to drive optimum results. Investment in technology will ultimately drive expedited claims technology and long-term industry success.

For the associated Insight, “Fast Track Your Claims Processing,” click here.


1 “The future of CX in insurance,” pg. 5, Talkdesk.com

EDWARD SULLIVAN

Edward Sullivan is a Sales Director at Vitech Systems Group. He manages various relationships with insurance companies across North America and helps lead new business efforts for the Life/Annuity market. Prior to joining Vitech Systems Group, Ed led new business efforts for Celent, a division of Oliver Wyman, Inc., focusing on Insurance and Banking in North America. Ed has extensive experience in customer relationship management as well as lead generation and competitive analysis.

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                    Gartner, Magic Quadrant for Life Insurance Policy Administration Systems, North America, Richard Natale, 5 August 2019.

                    Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.