In the insurance sector, a claim is a request by the insured (the customer) to avail the policy benefits from the insurance company (the insurer). Right from the first step – the insured places a claims request, until the last step – the insurer approves the claims request, the Claims Processing is a complex workflow.

Claims Processing Workflow:

With the above workflow, it is clear that claims processing is complex requiring data or information sourcing from internal and external systems for claim assessment, claim approval, claim classification, claim payment calculation and claim settlement. If this complex process runs manually, then it results in human errors, inaccuracy, high time consumption and ineffective customer service. So, to sophisticate the process and achieve the best results RPA (Robotic Process Automation) is essential.

Challenges with Manual Claims Processing:

• Lack of governance and cohesiveness 
• Longer processing time 
• Nuances in extraction of data and claim verification 
• Risk of manual intervention during reconciliation 
• High Operating Costs 
• Not Meeting Compliance 

How Diligent Group Solves Claims Processing Challenges with RPA?

Though, all insurance companies have similar claims processing workflows but they include some customizations as per their customer and business needs. With extensive insurance claims processing knowledge, Diligent Group RPA consultants understand the customizations that insurers made to their claims processing. Our RPA implementation includes the following stages:

• RPA Feasibility Study and Assessment
• RPA Strategy, Design and Roadmap
• Bots Creation for Intelligent Automation
• Validation

We address manual claims processing challenges by creating intelligent bots that work across insurance companies’ systems for:

• Data Extraction
• Automated Claim Assessment
• Automated Decision Making on Claim Rejection
• Automated Claim Classification
• Automated Claim Calculation

We can also implement the business rules that insurance companies wanted in their intelligent robotic process automation.

Results Diligent Group can Achieve with RPA in Claims Processing Compared to Manual 

• Upto 50% Reduction in Average Claims Processing Time
• Upto 30% Cost Reduction in Claims Processing
• Upto 80% Improvement in Claims Processing Effectiveness
• More than 50% Improvement in Customer Satisfaction
• Month-on-Month No backlogs in Claims Processing