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Case Study

Insurance Claims Management and Care System

Service Provided: Web Based Solution

With 90 million customers the organization is one of the largest global providers of insurance, annuities, and employee benefit programs, in over 60 countries. The company has been offering insurance protection to individuals and businesses in Bangladesh since 1952 and offers a variety of insurance policies such as life, dental, hospitalization and disability, and these are offered to both individuals and groups. ‘Insurance Claims Management Application’ helps an Insurance company to efficiently manage, process and validate insurance claims. This application allows the insurance company to manage the claim process with automated workflows ensuring that all claim data and each detail of every processing step are recorded within a centralized system. Claim details can include claim submission data and files, document verification, claim adjudication, relevant policy information and claim payment settlement

Challenges

Previously one of the complexities were manual process of Claim submission, review, validation, and payment. There was no online platform to submit claims. After submitting claims, it used to require huge time for claim decisions. As there was no fraud detection or auto claim calculation capabilities, it took more time to process.

Also, Adjudicators used to take more time to review a case and forward the case to the next step.  And the claim investigation process was slow.  The process of customer notification and information for submitted claim was not swift either. After processing a claim, it required 5-7 days to disburse. The whole manual processing needed more manpower and duplication of work, which generated more expenditure. 

 

Solution

• The web-based automated software solution for “Insurance Claims Management and Care System” was developed in response of the challenges. The system processes the submitted claims quickly and efficiently by utilizing configured rules and criteria for the claim processing. The system facilitates claims processing with a customer-centric service attitude, in which claimants are now notified about the claim process via SMS, Email, and Standard letters.
• The system can also detect fraud, which makes it easier for adjudicators to review a case and resolve it faster than before because when a case fulfills all the applied criteria, it might be auto-adjudicated by the system.
• End-users now can submit data and documents for approval through the claim submission portals where the claims management software can be used to process both group and individual claims.
• The system computes the amount of the applicable claim for each customer, significantly reducing human intervention and error rate. Whereas it used to take about 15 to 30 minutes to manually calculate the amount of the claim, the system can now do it in less than 30 seconds.
• This solution also enables the customer service center to respond appropriately to their customer queries.

Impact

As the system is a web-based automated software solution for claim processing, policyholders can now submit their claims along with valid documentation against their policy through this system to receive the claim amount which required more time and effort previously. According to the company’s report, this claim processing system allows claims to be settled nearly 70% faster, allowing them to reduce claims management costs, reduce fraudulent claims, and improve customer experience.

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