Making the Case in Claims Processing

Today’s Post By: Will Sellenraad, Principal, Insurance, Pyramid Solutions, Inc.

According to the Association for Information and Image Management (AIIM), 52% of organizations work from three or more systems and 62% of organizations strongly depend on the file share as a key repository.* That means insurance providers are unintentionally using disparate processes and creating content dumping grounds.

The headache begins with structured logic (aka workflows) that cannot manage exceptions and everyday changes such as incomplete information, background searches or requests for additional information.

It’s amplified by unorganized content that demands adjusters to jump between applications/systems dreadfully searching trying to find the information needed to make a correct and important decision- Should I pay out this claim or not?

Leading insurance providers have bypassed these common pains by leveraging document capture and case management technology. Providers are now automatically capturing content from virtually any channel and properly managing content. Automated rules aggregate (previously siloed) claims data, policy information, supporting documents, audio, video and photos into a case file, and route incoming claims to adjusters based on type, skillset and workload.

Advanced case management solutions with document capture, can help significantly reduce cycle times and operating costs for claims departments. They allow multiple adjusters to work on a claim at the same time and make ad-hoc tasks feasible. Shared content is the foundation of this approach. It brings people, processes and information together in the context of a case, making claims processing a dynamic and fluid system.

While shared content is foundational for advanced case management, advanced case management is foundational for high client value.

Watch our 10 minute on-demand webcast to hear how insurance providers can harness case management to help reduce costs, process claims faster and most importantly, provide value to your customers.

Watch Now!

This blog is the third in a four-part series: Smarter Content, Smarter People, Smarter Claims Processing. Interested in following along?

Part 1: The Insurance Landscape

Part 2: Empower Your Claims Reps

Stay tuned for Part 4: Focusing on Smarter Claims Processing

* Source: AIIM Market Intelligence ECM Decisions 2015

 

Empower Your Claims Reps by Putting Content to Work

Today’s Post By: Will Sellenraad, Principal, Insurance, Pyramid Solutions, Inc.

Imagine cutting 13 minutes off the time it takes to process every claim.

Now…

• Multiply 13 minutes by the number of claims a single handler processes in one week
• Multiply that time by the number of handlers your institution has
• Finally, multiply that by the 52 weeks in a year

That’s how much time your organization could save in one year by providing your handlers with the right tools to process claims.

Your claims reps will only be as good as the tools provided to them. That’s why it is the institution’s job to empower its claims reps by providing them with a variety of tools and tactics to successfully and efficiently process a claim.

One of these tools is an interface that provides a 360-degree view of a claim.

 

When a customer calls, a representative will have the entire customer claim file in front of them to answer any and all questions the customer may have-from items still in processing stages, to images the customer submitted, to past customer claims and information. The handler does not have to jump from one application to another searching for relevant items, which saves 10-15 minutes of time for every claim, for every claim rep.

This is what advanced case management is all about. It’s based on a solid content foundation that makes insight, accessibility and visibility possible. Tools that support a solid content foundation are context-based searching, document bookmarking and tagging, parallel processing and document split and merge.

Case and capture solutions enable organizations to capture content from virtually any channel in real time, update cases for a 360-degree view of a customer and manage content for its lifetime based on a solid content foundation.

By investing in tools that empower your claims reps, you’re investing in your organization’s success. Saved time and smarter claims reps means more claims processed and happier, loyal customers.

To learn more about the different ways you can empower your claims reps, watch our 10-minute on-demand webcast: Empowering Your Claims Reps.

Watch Now!

Sherlock Holmes in the 21st Century

Today’s Guest Post: David Jenness, Portfolio Manager, Case Manager and ECM Messaging Lead, IBM

I recently received as a gift “The Complete Sherlock Holmes,” and I read it (four novels and 56 short stories) from cover to cover. In “Sherlock Holmes,” Arthur Conan Doyle created an indelible character, the super sleuth. An independent thinker, Holmes combined keen observation, deductive reasoning and a deep well of research to solve the most complex and baffling mysteries.

Often the cases Holmes pursues hinge on the color of mud on a man’s shoes, the smell of ashes from a cigar, or the peculiar shape of a woman’s ear. London at the close of the 19^th Century was the center of a global empire and Holmes’ personal knowledge base included an ear for English dialects, a deep understanding of chemistry, which extended to Indian spices, South African poisons, and Chinese herbal medicine, a degree in European geology, and – perhaps most important – an encyclopedic study of criminal methods from history.

Look at the sensational headlines of today and you will see many similarities to London a century ago, only everything is moving much faster. Yet, observation, reason and research remain the three pillars of investigation. Whether you’re tracking criminals in law enforcement or product counterfeiting, fighting fraud in loan origination or insurance claims, or seeking insight from data or content repositories, you need the same cognitive capabilities that Holmes used.

And now you can.

The modern investigator can draw upon an array of investigative analytics, structured data and unstructured content, and consult subject matter experts, who can collaborate in real time, all within a single user interface that tracks every step in the investigation. It’s called IBM Case Manager for Investigations, a solution that provides new tools to help companies and government agencies understand criminal behavior or track product quality, health issues and customer sentiment.

You can see a live demonstration of IBM Case Manager for Investigations on Wednesday, December 16 at 10 AM PT, 1 PM ET. Use this link to register: http://bit.ly/1OoLc6t.

As magical as Sherlock Holmes’ investigations seemed to be, once you understand the methods, the magic evaporates. As Holmes himself scolds his friend, Dr. Watson, more than once: “Detection is, or ought to be, an exact science and should be treated in the same cold and unemotional manner.”

Manage the Unpredictable with IBM ECM

Today’s Guest Post by: Dave Perman, Sr. Product Manager, IBM Case Manager

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It’s all well and good to make sure your employees can see the information they need when they need it. But they should be able to do more with your content—and they can with IBM Enterprise Content Management (ECM).

The world and, thus, the context surrounding your content, is always changing. The economy is always moving, businesses are either shrinking or growing, and employees are all over the country or even the world. This clearly results in unpredictability in everything we do and encounter. By giving your employees access to your most accurate and up-to-date content, you allow them to make more effective and efficient decisions and act on them.

But what’s the point of just being able to view the content? That’s only half of the necessary requirements for effective work. IBM ECM advanced case management enables your employees to apply analytics for insight and to interact with content and one another—to drive improved collaboration. That added insight allows them to confidently and decisively act on behalf of the business, no matter where they are or what device they’re using.

IBM ECM gives organizations power over their content and makes it Smarter Content Now.

The world may be unpredictable, but you can prepare for it with IBM ECM.  See how other organizations are IBM Case Manager by download a copy of the Forrester Total Economic Impact report.