The day in the life of an Insurance Claims Payer is fast-moving to say the least. Imagine a day spent answering calls from claimants, providers, and employers, reviewing 100s of page of medical records, reviewing, and documenting information received (i.e. claim forms, payroll records, Attending Physician Statements), finalizing claim decisions, drafting, and sending emails/letters, requesting additional documentation, discussing claims with medical/vocational resources, calculating payments, offsets, overpayments…I could go on and on, but you get the idea! Now imagine doing ALL this using technology that is decades outdated! A lot of attention is focused on the Customer (claimant/employer) Experience during the claims process and rightfully so, but we should also be focused on how the impact the lack of technology impacts the User (claims-payer) Experience and the financial costs associated.

Outdated technology causes a multitude of challenges for Claims Payers. Many processes remain manual, causing inefficiencies for Claims Payers trying to manage 100+ claims. Often Claims Payers are expected to duplicate or even triplicate information into systems that do not “speak” to each other. The domino effect is the delays that these inefficiencies cause, including not making a claim decision at the earliest possible time, missing a return to work notification, or delayed notification of an offset. All these delays can have financial impacts not just for the Carrier but also for the Claimant.

With manual processes and inefficient workflows also comes the potential for human error. A wrongly entered date or transposed dollar amount can have triggering effects throughout the life of the claim and may take months to catch. This causes not only financial impacts on the Carrier and Claimant but also significant re-work for the Claims Payer while managing a very likely upset Claimant.

Outdated technology also causes increased operating costs and missed opportunities around automation for cost savings. Beyond the cost savings of automation, and maybe equally important, is the positive impact automation would have on Claims Payers. Some in the Insurance Industry view AI/automation as a means to end their employment. In actuality, AI/automation will increase efficiency and assist Claims Payers with focusing on the right claim, at the right time, for the right reason. AI/automation will bring efficiency to the Claims Payers role like they have never experienced before.

Ultimately, by investing in updated technology and AI/automation, Carriers are going to increase customer satisfaction, decrease potential fraud/compliance issues, all while having efficient and satisfied claims departments – less turnover, stress with day-to-day activities, and increased focus of risk management of claims.  That sounds like a win to me!

Want to know more about how updated technology and AI/automation can help your organization? Contact Owl.co!