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Here’s How You Can Make Real-Time Claims Possible Today

Much like the rest of the entities that make up the financial industry, insurance companies are in the midst of a digital revolution.

This so-called Third Industrial Revolution is characterized by the shift from mechanical and analogue systems to ones that are based on digital technology.

Using digital solutions has enabled numerous global players in the financial industry to improve the efficiency of their internal processes, reduce the cost of their operations, and innovate the products and services offered by the competition.

At the same time, digital technology has been at the forefront of the fight against financial criminal activity, so much so that failing to embrace the digital revolution today can prevent a business from keeping up with the standards set by regulatory bodies and setting itself up at a disadvantage.

One of the areas where a digital insurance management system can make a significant difference is in processing real-time claims. This capability is becoming increasingly important as it makes a lot of impact on customer experience, with many customers preferring to work with an insurance provider that can assure them of a shorter turn-around time for their claims.

Given the ongoing pandemic and the onset of what experts deem to be the start of a climate crisis, a shorter claims processing time is key to eliminating present and minimizing future backlogs and bottlenecking issues in an insurance provider’s internal processes.

How can insurance companies carry out real-time claims processing with the assistance of digital systems? Here are the capabilities that digital technology can provide insurance companies:

Flexible Product Definitions

In the past, consumers were content with limited insurance offerings, but today’s consumers want options. This is why it makes sense to offer modular products that customers can mix and match according to their specific needs.

However, providing plenty of products to customers can make it difficult for insurance companies to process claims later on, as they need to sort out different categories of benefits while doing so. The good news is that digital insurance management solutions can be configured to offer tiered categorization of coverages and benefits, and this can speed up the claims processing time.

By using code sets and prepared parameter definitions, an insurance provider can simplify its product categories without limiting the number of package options that it provides its clients.

Agile Claims Pricing

Supporting a wide range of products can be quite taxing to insurance providers, as this would require them to deal with extensive rules for calculating prices. Such a system can slow down their claims processing functions. This is not the case for companies that make use of digital solutions with template-driven setups for pricing contracts and clauses.

Such a system is capable of automating price claims and categorizing the claims that need to be paid out per claim line, taking into consideration the insured’s medical needs and diagnosis, for example. The capability to bundle payments together under a single claim or across multiple claims can significantly reduce the time the insurance company needs to respond to the needs of its clients.

Real-time Claims Adjudication

The ability to bundle claims together in a single episode of care is key to real-time claims processing. Backed by this capability, insurance providers now have the option to use preconfigured claims processing flows that will enable them to achieve high adjudication rates.

The insurance management system can be configured to recognize duplicate claims, enforce filing limits, and even set the criteria that call for mass reprocessing. The system can take care of all these processes while requiring minimal human input, and because of this, the insurance company can immediately scale up its operations when needed, all without extending its claims processing time.

Automated Authorization

Despite needing a claims processing system that is capable of automating authorization, insurance companies should still be able to grant one-off authorizations when needed. To do this, they need a claims modernization solution that can collect the data included in authorization requests.

This information will then be used to improve pre-configurable matching rules, thereby enabling the system to provide automated authorizations to similar cases as well as one-off types of claims.

Investing in Real-time Claims Processing: Setting a Strong Foundation for Future Success

Faster claims processing is key to providing customers with exceptional experiences today, but shortly, this will be considered a basic capability for any insurance company. It’s worth noting that the expectations of the current generation of customers are changing all the time.

Digital natives, for example, are aware of the advantages that digital technologies lend to the companies they subscribe to, and as such, their expectations for their insurance provider’s claims management policies can be vastly different from the generations that came before them.

Investing in a real-time claims management system today, then, is crucial to meeting the needs and requirements of the next generation of insurance customers.

By embracing the digital revolution at this crucial time, an insurance company is taking a solid step in ensuring its continued operation and keeping a keen edge over the competition.

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