5 Must Haves for Effective Claims Processing

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

How efficiently do you process new claims that arrive by email, fax, paper and mobile?

Can your claims processors retrieve customer data across all departments in one search? What about the ability to analyze content to identify patterns of similar claims by the same claimant?

Through our work in the insurance industry, specifically with claims departments across the nation, we found that for organizations to take full advantage of their content and process claims as efficiently as possible, they need the following must haves:

1. Capture with cognitive recognition for claims applications and supporting content (photos, tickets, hospital bills, etc.)
2. Protect the content and valuable customer information
3. Business Rules to activate automatic workflows and reports
4. Analytics Dashboard for real time KPIs to meet your SLA’s and more
5. Engaged content for greater collaboration between agents, members, and claims workers

The core technologies that support these must haves are advanced capture, dynamic case management and your claims system of records. From our experience, content is 20% of the claims processing that causes 80% of the exceptions.

If you have smarter content, you’ll have the tools to help process claims smarter. I invite you to watch our 10 minute on-demand webcast to learn more about the five ways to act on claims content. You’ll also hear how previous clients like the Great American Insurance Group streamlined content and processes and positioned themselves as leaders in the industry.

If you missed parts 1-3 of our Smarter Content, Smarter People, Smarter Claims Processing- don’t worry, you can view parts 1-3 here.

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

 

What are the sources of a technology decision delay?

Today’s Post by: Laura Ziegler, Marketing Manager, Image Process Design, LLC.

Insurance companies are frequently in a quandary. Faced with changing regulations, mergers and acquisitions, and increased competition, prioritizing these challenges alone can be cumbersome. Throw in the decision to invest and implement an Enterprise Content Management system, and it can feel downright impossible and intimidating. It is easy to focus on the investment costs and risks and downplay the benefits and returns. Over the course of the next few months, this blog series will focus on various aspects centered around one critical question for insurance agencies: what is the cost of delaying a technology decision?

When an insurance company looks to make an ECM decision, this usually involves making improvement in critical knowledge worker areas, such as: Claims, New Business/Underwriting and Policy Owner/Member Services. ECM modernizes the user experience and adds missing capabilities including work flows, case management, rules, content management, integration, analytics and mobile collaboration with customers. Tied heavily into this decision is the need to make a technology decision.

What is a technology decision, specifically for insurance?

A technology decision is an investment in hardware and software technology which includes major enterprise technology purchases. These decisions frequently involve input from multiple stakeholders. Technology investments are driven by the need to improve business agility, improve ROI, lower operational costs and streamline processes. However, a new tech driver has taken precedent: the client. The client is demanding that insurers have a complete picture of their needs and it requires departmental technology that aligns across all lines of business and can be accessed from anywhere. Technology decisions are complex and cumbersome because there are multiple stakeholders and because it requires forecasting and prediction: predicting immediate and future needs and impacts of our decisions, such as picking a product, choosing a vendor, funding a project or launching a new program altogether. This can be daunting and overwhelming to the most agile enterprises. As a result, we can become paralyzed in our decision making process.

Now, let’s dive into five possible sources of delay for this technology decision.

• Unknown Fear – Many business units do not know how best to manage a technology decision. How do you identify what systems are even available?
  • Solution: identify experts and reach out to peers to learn how they approached similar decisions
• Lack of capital – To implement a new system can be costly and often requires significant funding at the onset of the project. Many companies are concerned about ways to delay costs until benefits are achieved.
  • Solution: Consider a SaaS solution that allows insurance companies to invest at a lower capital commitment.
• Resistance – Inevitably, there will always be staffers that disagree on the implementation of a large scale system. These nay-sayers can derail an entire project fairly quickly.
  • Solution: Educate and obtain buy-in early on. Share success stories from experts and peers.
• Everyday work demands – Frequently, insurance companies are consumed with day-to-day issues, heavy workloads and various outside pressures that interfere with time available to develop a strategic plan for the implementation of a new system.
  • Solution: Waiting for a catastrophe is an ineffective way of operating a business! As soon as you realize you have a problem, react – search for a solution, evaluate options, and consider implementing a packaged solution. You and your company will be happy to see rapid benefits from the implementation, rather than try and scramble after disaster hits.
• Cost Overruns – Unexpected costs due to underestimation of actual cost during budgeting can be nerve racking and costly.
  • Solution: Packaged solutions can often be done at a fixed price with most of the functionality pre-built and available for immediate proof of concept or pilot. Consider SaaS over on-premise installation because the costs can be lower and variable based on actual usage. Additionally, internal resources are frequently minimized when SaaS is used. Many customers report lower upgrade costs in the future.

Don’t delay your journey into transforming your insurance company. Start off with our complimentary webinar on-demand from Insurance Networking News on how to infuse customer centricity into your business. This webinar will discuss ways leading insurers are using digital technology to help overcome the challenges surrounding staying customer-centric. Watch now: http://bit.ly/1QUB476.

Leveraging Datacap for Large Volume Insurance Operations

Today’s Post By: Chris Leach, Director of Perficient

Online forms, paperless processing, mobile applications, digital transformation – all part of the wave of the future.  Still, today’s property and casualty insurers remain inundated by paper. One large national insurer recently upgraded their entire ECM infrastructure from FileNet Image Services to FileNet Content Manager, including the replacement of number of ingestion channels with Datacap.

To help quantify “large”, this particular organization ingests between 400,000 and 500,000 documents per day. These documents come from numerous sources. Scanned and faxed documents represent about ½ of the volume, with content from electronic feeds making up the balance.

The nature of the operations is such that there isn’t the need – nor the business value – to try to capture field-by-field data. For the most part, this kind of data (accident date, VIN, policy number, insured’s name, etc.) is already entered online, usually at time of First Notice of Loss. With the subsequent incoming content, all that is generally needed is a claim or policy number to match the inbound document to the correct folder – and to initiate a workflow process.

This matching process, however, can be tedious. Inbound faxes and scanned documents are unstructured, and claim/policy information can appear anywhere on the document. This presents two problems. First, documents need to be manually indexed. And second, because the content on the documents is generally free-form, the needed information – policy or claim number – can appear anywhere on the document. Index users must scan through the content looking for the right information, and then key that information. The need to search through the document and locate the information makes the indexing process significantly slower.

Enter Datacap.

This insurance customer opted to take advantage of Datacap’s full-text OCR capability on each inbound scanned and faxed document. This generates text output for each clearly discernable word on the page. Datacap then searches through those words to locate a claim number.

In this scenario, the claim number will (a) follow a specific numeric pattern; and (b) contain a check digit. By using Datacap to automatically search for the claim or policy number anywhere in the document and then applying specific business rules to validate the claim number, the time required to index this huge volume of documents is significantly reduced.

This insurance customer was able to optimize its Datacap-based OCR solution with two simple steps:

• Upfront analysis: First, by analyzing fax and scanned documents at the outset of the project, it was determined that if a policy or claim number appears on the document, it does so somewhere on the first two pages about 99% of the time. By limiting the full text OCR to the first two pages of each document (rather than searching every page, where the average document size is 8 pages), this increases the OCR throughput by a factor of 4, with very negligible impact on the number of documents that can be automatically indexed.
• Validating and augmenting the data: Second, by leveraging Datacap’s ability to invoke a web service to both validate the claim number and to obtain other necessary index fields, this insurer is able to minimize the amount of manual keying required.

With this combined approach, this insurer is able to automatically index over 75% of inbound documents with no user intervention – and the success rate climbs to over 90% of those documents with a legible, valid claim number! Overall, this allows complete straight-through indexing of a large volume of inbound, totally unstructured documents. This reduces the labor involved in indexing and increases the speed with which these time-sensitive document reach the claim and policy processors.

To find out more about Datacap, please visit: ibm.com/datacap

 

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!

Smarter Content, Smarter People, Smarter Claims Processing Series Blog 1: The Insurance Landscape

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

This blog is the first in a four-part series, titled Smarter Content, Smarter People, Smarter Claims Processing. You can also follow this series by watching our webcasts.

An insurance company ingests thousands of applications, invoices, claims, contracts, emails, videos and images on a weekly basis.

And not only do they receive all this content, but they also validate, process, store and protect it, to make sure no fraudulent activity or information exists in customer statements.

And while all of that is going on, the insurance industry landscape constantly shifts beneath their feet from globalization, commoditization and disintermediation perspectives.

It’s almost like asking a professional juggler to juggle an orange, knife, ball, plate and pencil and sing a song while walking on a tight rope. Sounds like a recipe for disaster, right? Well, maybe it is for the juggler, but there are tactics an insurance company can adopt to remain grounded and establish a competitive edge.

One of the most important things an organization needs to do is create a customer-centric enterprise. Leverage real-world knowledge to understand your customers and their needs. Take it a step further by driving that insight to all customer touch points.

A second tactic is to improve the flexibility of your company’s processes and streamline operations. When the land beneath your feet constantly shifts, your organization must be able to shift with demands too. By eliminating inefficiencies across your organization, you will yield better business agility and keep engagement levels high.

A third tactic is to optimize your enterprise risk management. Integrate risk management into core processes to adjust to new products and services, and to more easily adapt to market and regulatory changes.

Efficiently capturing incoming and outgoing content and processing structured and unstructured data will help your organization gain greater insights from your content to produce better outcomes for your customer and your future.

Don’t forget to watch our webcast, where industry experts, Will Sellenraad, Principal of Insurance at Pyramid Solutions, and Vincent Price, Enterprise Content Management Case Analytics Software leader at IBM, describe in detail the shifting insurance landscape and how you can remain competitive.

Make sure that you don’t miss our second blog of the series, which will reveal how to empower your claims representatives. Subscribe now!

Video Opportunities in Insurance

Today’s Post by: Michael Shrage  |  Director, Channel Management |  Kaltura Inc. |  (818) 749-1012 |   michael.shrage@kaltura.com  |  www.kaltura.com

Video is increasingly part of every business, from online training to executive messaging, marketing to internal collaboration. But some industries have the opportunity to go far beyond that in using video to streamline and boost their business. Today, leading insurance agencies are now leveraging audio and video across the organization for everything from the claims and underwriting processes, counter-fraud management, to employee and client communications. Because video makes it easier to capture key details in real time, insurance organizations have a major opportunity to leverage video to improve claim accuracy, shorten processing times, and reduce fraudulent claims.

Video is improving documentation for policy holders. Video gives a more detailed, easily comprehended view of objects and scenes than still photos ever could. A video walk through of building and home inspections provides far better data for underwriting purposes. Capturing accident and disaster scenes on video smooths the claims submissions process. Virtual appraisals are now possible.

The rise in the use of drones is only going to increase this trend. Drones can be incredibly useful in obtaining hard-to-get data. Using a drone to capture footage of building damage delivers a better angle and reduces the chance of employees and policy holders doing additional damage, or injuring themselves climbing ladders and clambering over rooftops. Accident scenes become easier to document and measure through analytics. Drones enable easier initial property surveys and make ongoing monitoring easier than ever before. In the event of a large-scale catastrophe, drones will soon be invaluable for conducting post-catastrophe surveying, triaging the damage, and planning personnel deployments effectively.

Scenes are not the only subject that’s captured better on video. Multimedia makes for a superior way to capture interviews, candid thoughts, and depositions. It makes it easier to capture more candid thoughts while interviewing witnesses and victims. Speech-to-text audio and video recordings of legal depositions streamlines the workflow. Video can be a more informative method to monitor calls in regulated environments.

Each of these techniques help to improve claim turnaround and accuracy, while simultaneously improving customer retention and the bottom line. But of course, these are not the only ways that insurers can take advantage of video. Video training can help speed employee on boarding and reduce training costs. Video interviews help make HR more efficient. Customer relations through video are more personal, relatable, and effective. Video makes it easier for far-flung colleagues to communicate, collaborate, and share knowledge, without traveling. Video is more engaging and efficient.

How can insurance organizations incorporate more video into their processes? Kaltura Video Navigator for ECM makes it easy to include audio and video in business process workflows, govern the multimedia content with life cycle governance principles, and eliminate content silos. It makes it easy for insurance companies to video-fy their workflow, to reduce costs, energize their workforce, and improve customer satisfaction.

Download to read more on Insurance use cases: https://ibm.biz/BdHNHy.  You can also start video-fying your organization with a secure corporate video portal leveraging the free trial on cloud here.

Cognitive capture for Banks and Insurance Firms

By Kevin Craine

Despite the increasing digitization of business today, most organizations and many key business processes are still awash in paper. And nowhere is the burden of paper felt more significantly than in the banking and insurance industries. At the same time, an ever-growing amount of digital content is part of the modern information mix.

For banks and insurance firms, managing the variety of documents and media types presents a number of challenges that impact organizational performance, not the least of which is the influence on customer engagement. Customer centricity is a key market differentiator today, and executives are looking to operationalize the strategy and drive key transformational changes. They need to increase employee and customer engagement in order to drive efficiencies and best practices across the organization.
Overcome the Burden

How can you boost customer centricity with ECM? One way is to make your capture system cognitive. IBM defines a cognitive system by its ability to understand, reason and learn; and in a sense, to think. IBM Watson is a cognitive system that can understand data, learn from it and reason through it. Industries as diverse as healthcare, retail, banking and travel are using cognitive capture to reshape their industries. Human cognition is the mental action or process of acquiring understanding through experience…and that’s what cognitive capture does as well.

Organizations today are challenged with meeting business objectives while ensuring a customer-centric approach. Today’s digital businesses struggle with working effectively and efficiently because of complex and variable types of documents and content entering an organization, multiple systems and screens, specialized application silos, and no easy way to record it all. The new dynamic workforce struggles to retain knowledge and access it when needed in order to serve its customers and constituents effectively and consistently across channels.

New Innovation from IBM

IBM is out to change all that with the new release of the IBM Datacap Insight Edition which provides an approach to cognitive capture that is an important tool in building a more customer centric approach for financial services and insurance firms. The system combines advanced imaging, thoughtful business rules, natural language processing, and machine-learning technologies like those used in Watson to automatically classify and extract information in real time from any type of document. This is extremely important for unknown or highly variable documents that directly connect with customers. Until now, those document types have been handled manually. Now, you can automate that process, speed the pace of business and increase responsiveness and service to customers across the board.

Real World Applications

Cognitive capture helps organizations from all industries leverage both unstructured and structured data to continually improve customer service and engagement. By understanding context and aspects of personality, a cognitive business can personalize and deepen engagement with customers. And by collating the most-advanced knowledge available and across the enterprise, the expertise and responsiveness of the entire firm is improved. By spotting patterns in both traditional data sets and unstructured data, organizations can design their activities and strategies to foster customer centricity across the enterprise.

Synergy, Savings and Service

In today’s business environment, there is simply no time for manual ingestion and classification methods when customers expect real time service and the very profitability of the firm hinges on efficiency and customer responsiveness. Cognitive capture provides an important advantage for banks and insurance firms looking to automate manual processes and achieve a higher level of performance and response. With cognitive capture, organizations are in position to engage new levels of case management, analytics and workflow automation that foster systems and strategies for a customer-centric organization.
What to find out more? Check out this video to see how IBM Datacap Insight Edition determines relevant content to extract for business uses, learns and classifies document types for future use and faster processing.

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Guest contributor Kevin Craine is the author of the book Designing a Document Strategy, host of Everyday MBA on C-Suite Radio, and a respected authority on document management and process improvement. He is the managing director of Craine Communications Group. For more information visit CraineGroup.com.

Can your Claims Management System effectively manage your content?

Today’s Guest Post: Misty Ahmadi, WW Content Marketing Manager, IBM Case Manager
Follow @heytheremisty

Many insurance carriers face similar challenges. One of the most common issues is the challenge of managing claims process and the content connected within each claim. As you review current claims process, are you concerned with any of the following:

• Reducing processing costs?
• Reducing internal touch points?
• Processing claims faster?
• Improving customer experiences?

Don’t evaluate these concerns on your own – our team invites you to join leading insurance experts in a free webinar! This webinar will discuss what types of solutions can help your agency overcome the claims process management challenge.

On Thursday, December 10^th, join our featured presenters, Vincent Price, Insurance Case Manager Solutions, IBM and Will Sellenraad, Principal, Insurance, Pyramid Solutions, Inc as they expose 5 common myths about managing content within your claims management system. Insurance experts will share how to extend your organization’s current claims management system in order to process claims faster and enhance settlement accuracy, all while facilitating an enterprise approach to your content management.

This free webinar is sponsored by IBM and Pyramid Solutions and brought to you by Insurance Networking News.

It’s not too late to register! Click here to register.

Case Management @ Insight 2015: Focus on Insurance

Today’s Guest Post: Misty Ahmadi, WW Content Marketing Manager, IBM Case Manager
Follow @heytheremisty

Last week I shared the exciting banking –focused case management sessions that you can expect to find at Insight 2015. This week, I’m equally as thrilled to share with you an insider peek at another industry track at Insight – Insurance.

Throughout the ECM insurance sessions, you’ll find a range of client presenters sharing about their experiences with cross portfolio ECM solutions. The insurance industry will also be featured in the Expo Hall at the insurance peds – come on by to learn even more!

For those interested in IBM Case Manager and insurance, you’re in luck. There are a few sessions that will focus specifically on how a great case management solution can improve your insurance business. I’d like to share three sessions I’m particularly excited about.

ACE Insurance and their business partner Vega ECM Solutions will share how they were able to automate regional financial and shared services processing with IBM Case Manager. They were able to have a global rollout of a scalable, industrial strength finance application and will have a great presentation on their methodology and technical details of the rollout.

If you’re interested in learning how a case management solution can help your business gather a holistic view of content through the entire policy lifecycle, we have a great session for you! By introducing an advanced case management solution, the property and causality division of Great American Insurance Group is streamlining content and processes to help teams work together faster, more effectively, and more productively.

We’ll also have a featured session on how the combination of IBM Case Manager and Kaltura Video Navigator allows the addition of video assets into existing case management procedures. Those in insurance know that video recordings of an accident scene, a deposition, or a field visit are valuable assets to speed up and improve case resolutions. This exciting session will describe how to integrate video assets along with other claim documents in a unified case workflow.

It’s not too late to register for Insight 2015, which is taking place in Mandalay Bay, Las Vegas on Oct 25-29^th. After registering, be sure to reach out to me on Twitter (@heytheremisty) and let me know what ECM session you’re most interested in attending. I look forward to seeing many of you there!