How to Automate Your Insurance Claims Process with Workflow Software

Blog: ProcessMaker Blog

For insurance companies, the claims process is a lengthy, complex process that has traditionally taken weeks to resolve. During the claims process, insurance companies have an opportunity to serve their customers quickly and more efficiently by adopting digitization. With the right technology, insurance companies can create new standards of service to drive down cost.

In this article, we’ll explore how to automate the claims process in the insurance sector with an intelligent workflow solution.

The claims management process

Claims management relies deeply on speed and accuracy to meet increasing customer demands. Normally claims involves several functions, including administrative, managerial, and customer service. A 2019 report by Accenture indicates that “in five years, nearly all the insurance executives expect the industry to be transformed by digital technologies.” It’s no wonder many are going paperless, despite the industry still being heavily entrenched in manual, paper-based processes. Insurers must overcome obstacles related to the lack of IT collaboration and issues that come with legacy solutions to realize the full value of investing in tech.

To stay competitive and serve customers to the best of their abilities, insurance companies are turning to workflow automation software to automate their processes. In fact, a company adopting automation technology can reduce the cost of the claims journey up to 30%. Before this kind of software can meet the needs of the insurance industry, a vendor must first understand the constraints of the sector itself.

The nature of the insurance business

Claims management isn’t the same as it is in healthcare or other industries. Claims differs in the insurance sector due to its seasonality that comes from natural disasters. Insurers needing coverage from these natural disasters purchase what is called catastrophic insurance. This is especially true for businesses dealing with these types of damaging weather conditions or vacation months, as seen often in coastal regions.

Managing seasonal highs and lows while maintaining waiting times and quality is critical to delivering excellence in customer experience. This also drives down claims cost. Temporary solutions like hiring seasonal employees creates a staffing inconsistency that requires retraining time and money, something these insurance companies try to avoid.

To overcome these industry challenges, some insurance companies are introducing software into their workflows either through a workflow, BPM, RPA solution or combination. These SaaS solutions focus on automating and streamlining data and workflows to reduce process timelines and maintain consistency of outcomes.

So what are the differences between these solutions? Below, let’s cover some definitions first:

BPM. Short for business process management. In layman’s terms, BPM is that strategy that takes the whole organization’s business processes into consideration. This includes everything from process design to modeling, analytics to implementation, and more. BPM software is the technology that connects and deploys the steps of each workflow. BPM software models and execute processes at scale compared to traditional people-based solutions. It’s also unique to workflow software, which doesn’t follow BPM methodology nor BPMN 2.0, a universal notation.
Workflow software. Workflow software achieves the same goal as BPM software, but is defined by Techopedia as “a software application designed for setting up and monitoring a defined set of tasks along with its sequence.” Sounds pretty similar to BPM software, correct? It is, except not all workflow software is BPMN 2.0 compliant. Examples include Microsoft Flow, IFTTT, and Zapier.
RPA. Short for robotic process automation. Investopedia breaks RPA down in simple terms: it is “software that can be easily programmed to do basic tasks across applications just as human workers do.” Hence, the robotic part. RPA is useful to automate what we’d consider menial tasks, like moving a cursor on a computer or typing into a software application. There’s no human element involved in someone filling out a request form for an approval, completing a purchase request, CRM assignment, and more.

Automating the claims process from start to finish
Insurance companies have numerous processes that are traditionally operated manually. For claims specifically, these areas cover three major phases of claims management: First is data entry, second is decision-making, and last is payouts.

For claims input
With the help of a workflow engine and software solution, time and effort is reduced by handling pre-entry and post-entry tasks. For example, the software applies preset rules to determine whether that claim requires data entry. The software then assigns the claim to the correct person, like an administrative employee. The worker receives the claim, inputs data required, then moves on. In some cases, the claim can stay “Pending,” meaning that claim is then designated for the claim exemption process.

Claims exceptions
Today many claims are decided within an automated process, although some do require human interaction. It is here that claims management becomes time-consuming and expensive. Suspended claims can experience up to a month or more in delays. In a traditional claim exception process, claims marked as exceptions are normally sent to an employee for manual processing, requiring time and effort to find the correct information needed to process the claim.

Similar to the input process, workflow automation software intuitively sends these claims to the appropriate party based on preset rules. Due to the nature of combining RPA and BPM, this software is able to identify repetitive patterns and automates these tasks. The entire claims exception process then becomes streamlined and intelligent as less human interaction is needed.

Ready to accelerate your enterprise’s claims process?

An efficient workflow automation solution is critical for insurance companies to exceed customer expectations. Workflow automation delivers value to these companies by:

Enabling digital management of processes
Adding visibility into transactions and process elements
Going paperless and eliminating costs and associated waste
Increasing productivity by automating manual tasks

With the right BPM platform, the claims process can go from tedious, lengthy, and frustrating to automated. Businesses need to be able to create workflows that leverage existing systems and can provide them with agility. Most of all, the right BPM platform can enable business to create, deploy, and leverage existing system value without coding.

Our award-winning workflow platform has helped insurance companies like yours automate the claims process. Read more about how we helped Maury, Donnelly and Parr Inc. (MDP) — a leading insurance company based in Baltimore, Maryland — to win the 2019 WFMC for BPM Excellence earlier this year.

About ProcessMaker

ProcessMaker is low-code business process management and workflow software. ProcessMaker makes it easy for business analysts to collaborate with IT to automate complex business processes connecting people and existing company systems. Headquartered in Durham, North Carolina in the United States, ProcessMaker has a partner network spread across 35 countries on five continents. Hundreds of commercial customers, including many Fortune 100 companies, rely on ProcessMaker to digitally transform their core business processes enabling faster decision making, improved compliance, and better performance.

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