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Insurance Solutions
Insurance Claims Outsourcing Company Seeks Automation for Claims Process
Our client is a customer response management company that provides a multifaceted, quality-control monitoring for driver safety, customer service, and insurance claims processing. These services are offered to companies of all types and sizes. The insurance claims division had a need to streamline claims document processing and paper based workflows. Their volumes had nearly doubled and they had resorted to printing faxes and pushed them through a manual paper process. Our client had issues with busy signals, calls not being answered and over all hardware reliability issues associated with their existing fax solution.
Prior to the implementation of our solution, our client processed claims by printing emails and faxes and pushing them through a paper based process that required manual entry of data into various back-end systems and on various sheets of paper, for tracking purposes. In an effort to maintain SAS70 and HIPAA compliance, our client, as a service organization, had to demonstrate they had adequate controls and safeguards when handling client data. By using a paper based workflow, our client was at serious risk of compromising sensitive information of both their clients and their client’s customers. Further, this client had a Service Level Agreement (SLA) with their customers of two (2) hours to process an incoming claim. They were experiencing claims processing time over eight (8) hours. The manual, paper process was part of the reason the SLAs were not being consistently met. After reviewing the Claims process, we determined that reporting on the status of a document in its life cycle was cumbersome or virtually non-existent. It was difficult to know at any given moment, where the document was in the process. Our client required a more robust method of tracking and reporting as well as the ability to view documents at any stage of the process.
Benefit/ROI
- Maintaining their SAS70 and HIPAA compliance
- Ability to automatically send batch faxes
- Reduction in printer/toner costs and paper costs
- Freed up management to focus on their job responsibilities and not paper distribution
- Enabled "first in, first out" process for claims
- Digital Time and Date stamping on all documents for auditing purpose
Our client had the following requests for the implementation:
- Email Integration with Exchange
- PDF capabilities
- Archive integration (Search, Index, and Scan)
- Fax Module integration with existing digital telephony and email platform
- Web-based interface with the ability to be accessed from home
- HIPAA and SAS70 compliance
- Reduction of costs associated with paper based workflows
- Training
- Scalability for expansion to other Corporate Divisions
- Rapid Deployment: “Go-Live” within 30-days of implementation
Our client processed approximately 2,400 pages per day via scanned mail, email, and fax. This equated to approximately 200 claims per day. They had a team of 10 employees keying data from Monday through Saturday from 8:00 AM till approximately 11:00 PM. Prior to our go live, each employee would visit the manager’s desk and extract their stack of work from the assigned mail box. They would return to their desk and key data into their claims processing system.
The manager spent most of her time each day, collating faxes, email and "stamping" each document with a time/date stamp. She would place the work into each of the worker's folders. If the work wasn't completed the same day, the work would be returned to the manager and she would divide it up amongst the employee for the next day's workload. Each employee was paid for performance so tracking the accountability of employee was challenging.
The client opted for our Rightfax and Alchemy modules for the implementation of automated workflow. By using the digital technology of RightFax and the built in connector to Alchemy, our client was able to import faxes and e-mails automatically into a digital archive. The faxes and emails were then imported into the Alchemy system and indexed for future retrieval. The project took three (3) days to complete. They client is now working on leveraging the applications with special codes and customizing the system through the use of the Application Programming Interface (API). They will further see the savings once this implementation is fully realized.
Collaboration Improves Lives
This simple axiom drives everything we do. It shapes how we approach problems, execute solutions and measure results. It’s not enough to be a real-time organization; you need to facilitate real-time collaboration. We do this using the Adaptive Exchange Methodology.
The Adaptive Exchange Methodology uses a stack of technologies called the Snapsflow Framework. Each technology is focused on overcoming specific challenges in achieving Real Time Collaboration. The Holon Framework was built, from the ground up, to be configured into combinations that lower the technical and human hurdles to collaboration while optimizing strategic agility and operational efficiency.