Insurance Claim Management System

Objective

This primary goal was to speed up the processing and settlement of claims by lowering turnaround times, lowering operational costs, and enhancing accuracy. Additionally, it had to improve case administration, further automate the payment and calculating process, and generate advanced claim analytics.

Clients Requirement

The client requested the development of a software that can operate an easy submission process from any device, track claim progress, enable online claim payments, and be simple and secure. Encryption must be used to protect all personal information. The majority of the app's functionalities had to be accessible even when the user was offline.

Client: Insurance Companies

Services: Claim Management System

Challenge

Application Security and User’s Privacy

The challenge was developing software that can increase the accuracy of claims processing, which reduces leakage by improving decision-making in areas including fraud detection, reserve setting, damage estimation and coverage, and benefits review.

Malicious Claim Protection

The claims management solution is more frequently weakened by opportunistic and malicious claimants. They needed insurance providers to implement foolproof systems that rely on pre-existing databases and fraud indicators, which further slows down the complaint process. We had to create a system that had to live through the situation and deliver proper service.

Multiple Touch-points

Since there are numerous parties involved and personnel must exchange data back and forth, errors are more likely to occur when there is a breakdown in communication or the absence of a uniform platform. Additionally, rather than receiving a comprehensive 360-degree perspective, providers and insurers receive a fragmented consumer experience.

Solutions

Document Management

Insurance companies can manage their vital claims-related documents by storing and arranging them with the aid of claims management software.

Advanced Scrubbing

Advanced scrubbing is important for cleaning most of the claim details and data. The advanced scrubbing technology will reduce the redundancy involved while filtering the inappropriate data. By scrubbing claims on the main and secondary levels and checking for LCD and NCD code compliance, a claim management solution with advanced scrubbing capabilities will reduce rejects and denials.

Advanced Reporting

The claim management system creates data that the insurers can use to track progress and monitor performance. All necessary information is provided by a reliable reporting mechanism. It even helps users follow through on feedback. It aids in identifying the essential remedial actions to maximize production and profitability.

Centralized Database

The centralized database houses all the documents and data. By acquiring files and documents through a shared platform, claim handlers can communicate and receive feedback on the spot using claims processing software.

Claims Process Tracking

The program with the straightforward tracking tool was created to keep track of the many stages of a claim. Customers can use the functionality to easily understand exactly what is needed of them before submitting a claim. Along with it the dashboard to track their claims history and total amount claimed was created to keep users informed.

Results

The application has reduced the turnaround time, minimized operational costs, and improved accuracy to expedite the processing and settlement of claims. Our client was able to increase their operational efficiency by around 3% within the first 3 months. They also used advanced claim analytics to automate payment and claim calculation thereby enhancing overall efficiency and productivity.

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Insurance Claim Management System

Objective

Clients Requirement

Client: Insurance Companies

Services: Claim Management System

Challenge

Application Security and User’s Privacy

Malicious Claim Protection

Multiple Touch-points

Solutions

Document Management

Advanced Scrubbing

Advanced Reporting

Centralized Database

Claims Process Tracking

Results

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