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New Claims Processing Automation Tools and Technology (2024)

Lari Numminen

June 16, 2023

The insurance industry has long been dominated by manual processes, leading to inefficiencies and increased costs. Deloitte estimates that claims processing accounts for up to 70% of an insurer's costs.1 As a response, claims processing automation has emerged as a game-changing solution. In this article, we will explore the concept, its benefits, the technologies involved, and the future of claims processing.

What is claims processing automation?

Claims processing is a critical part of the insurance industry. It involves receiving, verifying, and processing insurance claims from policyholders. This process includes assessing the validity of the claim, determining the coverage, and ultimately paying out the appropriate amount. Traditionally, claims processing has been carried out manually. Insurance agents, adjusters, and other staff members would handle each claim individually, reviewing documents, contacting clients, and making decisions on payouts. This method is time-consuming, labor-intensive, and prone to human error.

Claims processing automation streamlines and accelerates the process of evaluating, verifying, and settling insurance claims. By leveraging advanced new technologies, such as artificial intelligence (AI), machine learning (ML), natural language processing (NLP), and blockchain insurers can reduce manual tasks, minimize errors, and enhance the overall customer experience.

Key benefits of claims processing automation

By automating repetitive tasks and using advanced algorithms to analyze data, insurers can significantly reduce manual intervention, leading to faster, more accurate, and cost-effective claims processing. The four main benefits of automating claims include:

1. Speed and efficiency

Automated claims processing accelerates the evaluation and settlement of claims by reducing manual data entry and validation. As a result, insurance companies can process a higher volume of claims more accurately and in a shorter time frame.

2. Accuracy

Automation minimizes human intervention, reducing the likelihood of errors and inconsistencies in claims processing. This translates to improved accuracy and reduced risks associated with human errors, such as overpayments or denials based on incorrect information.

3. Cost savings

By automating claims processing, insurance companies can reduce labor costs associated with manual tasks, decrease the frequency of errors, and lower the overall operational expenses. McKinsey estimates that adopting clains processing automation can result in 30% cost savings.2

4. Better customer experience

Claims processing automation facilitates faster claim resolution and more transparent communication with policyholders. This leads to increased customer satisfaction and loyalty, as policyholders are more likely to receive prompt and accurate settlements.

Emerging Technologies Powering Claims Processing Automation

Claims processing software and tools have existed for a long time. In the past, they have relied on rules-based automation, but increasingly we're seeing solutions leveraging applied artitficial intelligence. Some of the key emerging technologies you should be aware of include:

  • Artificial Intelligence (AI) and Machine Learning (ML) - AI and ML algorithms enable claims processing systems to learn from historical data, identify patterns, and make predictions. These technologies help automate the evaluation and categorization of claims, detect fraudulent activities, and estimate claim amounts.
  • Natural Language Processing (NLP) - NLP facilitates the interpretation and analysis of textual information, such as policy documents and claim descriptions. By using NLP, automated systems can understand and extract relevant information from unstructured data, streamlining the claims assessment process.
  • Robotic Process Automation (RPA) - RPA automates routine tasks by mimicking human actions, such as data entry and validation. This technology enhances the efficiency of claims processing by automating repetitive tasks and minimizing manual intervention.
  • Optical Character Recognition (OCR) - OCR technology converts handwritten or printed text into digital format, making it easier for automated systems to extract and analyze information from documents, such as claim forms or medical records.
  • Blockchain. Blockchain is a type of distributed database or ledger most popularly used in cryptocurrencies. Blockchain can be applied to complex transactional actions, such as insurance claims management.

Emerging Claims Processing Automation Solutions

Process Intelligence

Process intelligence software can significantly help in claims processing by identifying workflow or task automation opportunities, reducing manual labor and human errors, and improving overall efficiency. By analyzing data and identifying patterns, it helps insurers to make informed decisions, detect fraud, and ensure compliance with industry regulations. This technology ultimately leads to faster claims settlement, enhanced customer satisfaction, and increased operational efficiency for insurance companies.

Intelligent Document Processing

Intelligent document processing (IDP) plays a crucial role in claims processing automation by efficiently capturing, extracting, and validating data from various unstructured and semi-structured documents, such as claim forms, invoices, and medical records. By leveraging advanced technologies like natural language processing, optical character recognition, and machine learning, IDP eliminates manual data entry, accelerates the processing time, reduces errors, and ensures accuracy in the claims processing workflow. This leads to better resource allocation, improved operational efficiency, and an enhanced customer experience for insurance companies.

Blockchain Insurance Claims Approval

Blockchain technology can be a game-changer for claims process automation in the insurance industry, offering transparency, security, and efficiency. By creating a decentralized, immutable ledger that records and validates every transaction, blockchain enables secure sharing of data between various stakeholders, including insurers, claimants, and service providers. Smart contracts, which are self-executing agreements with predefined rules, can be used to automatically process claims and trigger payments when specific conditions are met. This results in reduced fraud, faster claims settlement, and enhanced trust among all parties involved. Moreover, blockchain eliminates intermediaries and streamlines communication, leading to cost savings and increased operational efficiency for insurance companies.

RPA for Insurance

Robotic Process Automation (RPA) is a powerful tool for claims process automation, as it can handle repetitive, rule-based tasks with high precision and speed. By deploying software bots to perform activities such as data entry, validation, and claim status updates, RPA reduces manual labor, minimizes human errors, and increases overall efficiency. As a result, insurance companies can process a higher volume of claims with fewer resources, leading to cost savings and improved productivity. Additionally, RPA allows employees to focus on more value-added tasks, such as fraud detection and customer service, which ultimately enhances the customer experience and drives business growth.

Conversational AI

Conversational AI, powered by natural language processing and machine learning, can significantly contribute to claims processing automation by serving as a virtual assistant for both customers and insurance staff. Through chatbots and voice assistants, it can handle a wide range of tasks, such as guiding claimants through the submission process, answering frequently asked questions, and providing real-time updates on claim status. This not only reduces the workload for human agents but also offers personalized, round-the-clock support to customers, resulting in a more satisfying user experience. Furthermore, conversational AI can help insurance companies analyze customer interactions, identify trends, and improve their services, thereby contributing to overall operational efficiency and business growth.

Bottom Line

Claims processing automation is transforming the insurance industry by improving efficiency, reducing errors, and enhancing the customer experience. By leveraging advanced technologies such as AI, ML, NLP, RPA, and OCR, insurers can streamline their claims processes, reduce operational costs, and stay competitive in an increasingly digital world. Implementing best practices, such as process mapping, employee training, and performance monitoring, will help ensure the successful adoption of claims processing automation solutions.

Claims Processing Automation FAQ

What is claims processing automation?

Claims processing automation is the use of technology to streamline and automate the various steps in the insurance claims process, resulting in faster, more accurate, and cost-effective claims processing.

What are the benefits of claims processing automation?

Some key benefits of claims processing automation include improved speed and efficiency, increased accuracy, cost savings, and enhanced customer experience.

What technologies are involved in claims processing automation?

Claims processing automation technologies include optical character recognition (OCR), machine learning (ML), robotic process automation (RPA), and blockchain.

What are the challenges and considerations in implementing claims processing automation?

Insurers must address data security and privacy concerns, ensure seamless integration with existing systems, address employee concerns about job security, and consider the scalability of their automation solutions.

What does the future of claims processing look like?

The future of claims processing will likely involve further advancements in AI and machine learning, increased use of blockchain and smart contracts, and continued focus on enhancing the customer experience.

Written by

Lari Numminen

Chief Marketing Fellow