Electrical equipment

Claims management: how to make it easier?

glowing, colorful question marks

Claims management has always been the sharp end of the health insurance business, involving dealing with people when they may be vulnerable or emotionally struggling, whilst at the same time staying alert to the ever-present danger of fraud.

The part digitisation has to play in facilitating claims management

There can be fewer more radical shifts than the move away from a largely manual claims management system to one that is mostly automated. This has been driven by many factors, including the increasing amounts of data and greater number of variables that have to be dealt with in the insurance world, as well as the rising incidence of fraud and a generally tougher competitive environment.

Key advantages to a more digitized approach to claims management include the elimination of the need to process paper bills (which by itself offers huge cost savings). It also improves eligibility requests which can be made in real-time, speedier pre-authorization off the back of such real-time capable tech and quicker processing times at every stage of the process. In the end, this leads to quicker payments. Just as crucially, rules engines backed up by the power of big data are transforming the process of adjudication, with human error being largely taken out of the equation.

What’s more, a more digitised approach frees up employees, sparing them the more mundane tasks and ensuring their talents can be redeployed to work on particularly challenging or high-value cases, or cases where ‘soft’ skills are paramount.

How facilitating claims management can boost your bottom line

Easier, quicker claims management systems obviously provide opportunities for costs savings, but not necessarily just in the obvious areas such as fewer fraudulent pay-outs or employee headcount reduction.

On a very basic level, more digitisation means less paper – and paper takes up a lot of room! Increasingly digitised processes can allow businesses to reduce the amount of office space they need and thus cut down on one of their biggest outgoings. Less office space also comes with lower energy bills! Other typical office expenses like paper and printing supplies will take a hit as well. Taken together, this all creates significant savings.

Opportunities also abound to not just cut costs but boost growth as well. The increased efficiency of automation drives greater customer satisfaction and therefore retention – and even the chance for growth through word-of-mouth referrals. As we discussed earlier, employees will now have more time for more growth-oriented tasks, with companies able to use their workforces to move into new markets in a way that may not have been possible before.