Efficiency improvement at claims handler
International insurer makes major efficiency gains by using Avola Decision to handle claims
More efficient handling of claims as an objective
Customer focus is a top priority in every industry. Insurance companies are also increasingly realizing that consumers and business customers want quick action, flexibility and transparency. One of our clients in the insurance industry, which handles more than 100,000 claims annually, implemented Avola Decision. This improved efficiency, productivity and customer experience at this international company.
- Handling claims more efficiently
To save time on administration. - Working more customer-oriented
By freeing up more time for clients. - Find documents faster
By starting to process claims completely digitally.
Improve a complex, manual process
The biggest challenge was that handling claims was a complex, inefficient and largely manual process. Normally, claims handlers receive claims on behalf of their clients. To decide whether the customer should receive compensation and, if so, how much reimbursement they are entitled to, each claim must be personally evaluated by a claims handler. Because each client had different conditions and specifications that had to be taken into account, this is a complicated process.
Time-consuming task
To make things even more complex, the claims handling company works with Service Level Agreements (SLAs) for each customer. These agreements define and quantify how claims from these customers are handled. For example, step 3 in the handling process is not relevant to customer A and thus should be skipped. Customer B’s SLA states that the maximum turnaround time for a claim is 3 weeks, instead of the usual 4 weeks. It is abundantly clear that without adequate management of the rules contained in SLAs, handling a claim is a very time-consuming task.
A second challenge was spending too much time tracking down the right documents. Each claim was processed on paper, so tracking down the documents for a specific claim was not easy and led to delays in processing the claim. This led to productivity problems because claims handlers spent too much time handling a claim or finding a claim in the archives.
Translating SLAs into business rules
To simplify and speed up the claims handling process, the implementation of Avola Decision was chosen. This platform helps them identify the logic and rules used to make decisions. SLAs are an essential part of our client’s claims handling process and at the same time are the biggest obstacle to speed and efficiency.
Therefore, we recommended translating rules from Service Level Agreements into rules in decision models. As a result, Avola Decision enables the handling company to use the SLAs to efficiently manage the process. If the SLAs change along the way, the business rules in Avola Decision can be easily adjusted without help from the IT department. In this way, flexibility is also ensured.
What is Avola Decision?
Solution: 30% more efficiency, improved transparency and customer experience
By separating the business logic from the process and using SLAs to automate the claims handling process, the claims handler benefits from several advantages. Claims handlers no longer have to go through each step of the process manually. This has led to increased productivity and a decrease in lead time. With Avola Decision, the insurance company was able to achieve a 30% efficiency improvement.
When claims require human intervention or need to be handled before a specific deadline as stated in the SLA, Avola Decision automatically forwards the claim to the claims handler with the appropriate skills and prioritizes the claims that need to be handled first. Similarly, Avola ensures that claim handlers’ time and competencies are used as efficiently as possible. By integrating OCR technology, the platform can even interpret situation sketches on claim forms to help decide who is responsible for the damage.
Thanks to Avola Decision, the claims handler can put the customer first. By saving time in the claims handling process, there is more time to handle complicated cases and add a human touch. For example, if a client has been in a car accident, there is more time to ask how the client is doing and recovering. This seems like a trivial detail, but it can be vital to the customer experience.
Moreover, the platform has improved the transparency of the decision-making process. Avola Decision provides easy insight into the business rules used to reach a particular conclusion. Instead of a black box, the decision-making process is completely transparent. The platform also reveals the consequences of specific business rules. Users can easily test the impact of any changes. This allows the insurer to run several scenarios before actually making changes to the system.
Related:
- Efficiency improvement of 30%
Through partial automation of the
claims handling process.
- Customer first
More time for personal contact with the customer. - From black box to transparency
For uniform handling of all claims.
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