Month: September 2024

Customers have a simple expectation for every question they ask: ‘Yes, it’s possible.’ Whether they desire zero interaction with an agent when settling claims or need a sympathetic ear to ease their minds, it should all be seamlessly achievable. And one thing they absolutely dislike is having to repeat themselves over and over, especially during stressful times. This makes claims processing one of the most aggravating experiences they encounter. In fact, 87% of customers say that their experience with claims processing is what decides whether they stick with their insurer or look elsewhere.

On the other side of this equation, for the claims processors, the challenge is just as daunting. They are buried under a mountain of data, tasked with verifying it against claims submissions and coordinating with agents and beneficiaries—all within a tight timeframe. It’s a difficult job but what makes it so?

Incomplete Automation Coverage of Corner Cases

Most claims are straightforward and can be smoothly automated, but exceptional scenarios crop up, making the procedure notably more complex and manual. It’s these corner cases that increase costs and create bottlenecks, and insurers are finding it hard to push past with straight-through processing. Interestingly, these few troublesome claims are responsible for most of the costs. This includes revenue losses from claims-related penalties and similar financial setbacks. Claims usually make up 70% or more of an insurer’s expenses, so finding efficiencies here directly boosts profitability.

Pockets of Innovation Create Data Silos

While there has been real progress in automating parts of the claims process—from the first steps of authorization right through to settlement—there are still gaps, particularly in integration. Claims processors don’t have a clear, unified view, which makes it tough to keep everything running smoothly and quickly pinpoint where things get stuck, especially with the exceptions. This lack of clarity drags out the processing time and affects how fast claims can be closed out. The team must manually gather more information—consult external systems, and refer to procedural documents to ensure compliance and accuracy. And processors find themselves switching between multiple systems to find the root causes. What would really help is a ‘single pane of glass’ approach, providing all the necessary information in one, easily accessible place

The Target State: Efficient and Automated Claims Systems

Let’s walk through a typical Healthcare insurance claim scenario after a complex medical procedure involving multiple specialists. A claimant submits their form via a mobile app. And because the medical procedure is complex and involves multiple specialists and therapies, the claims processors need additional documentation and must do thorough manual reviews. The real challenge begins when we realize that the claim information is scattered across different systems—doctor’s notes are stored in one electronic health record system, lab results come through a separate portal, and prescription data is managed in yet another system.

What could streamline this for the claims processor? An AI-powered platform that can seamlessly orchestrate the entire claims processing journey. Multiple capabilities of such a platform would work together to enable true straight-through processing. For instance, Document AI that can effortlessly pull and make sense of data from various sources and formats, pre-populate certain fields, and provide summaries for the rest. AI-powered claims prioritization that helps in sidestepping SLA breaches, while natural language copilots offer real-time guidance to processors, auto-detecting anomalies like duplicates.

Such an approach could help manifest everything the customers need for the straight-through processing of their claims. The benefits are quite attractive: improved customer satisfaction, lower claim costs, and an increased capacity to handle more claims efficiently.

This past year has been tough on insurance. The outlook doesn’t seem much brighter either, and the ripple effects are expected to worsen. While the industry tries to sidestep these impacts, one key area that directly can influence both the costs and the overall financial health of insurance companies is underwriting. How?

Underwriting is a highly specialized and, quite frankly, expensive skill. It’s often described as an art form, and the instincts can only be developed with years of hands-on experience. Despite this, much of an underwriter’s time is consumed by repetitive, mundane tasks—the science behind the art that is ideally suited for automation.

While automation technology has been around for years, promising to ‘revolutionize’ every corner of business operations, a longitudinal study found that the life of underwriters has remained largely unchanged. The potential of automation to free up these skilled professionals to focus on more strategic, high-value tasks has not been fully realized.

Searching for Data in a Deadline-Driven World

Underwriting workbench remains a remarkably outdated, paper-first process. Data needed to assess risk is often buried in PDFs and spreadsheets tucked away in brokers’ emails. Underwriters must go through this fragmented information, moving between documents that are formatted differently depending on the source. That means much of their valuable time is spent rekeying information and other non-core administrative tasks.

For instance, underwriters frequently find themselves toggling through dozens of screens to extract the data required to price a risk. They repetitively rekey the same information into multiple systems, making the underwriting workbench just another cumbersome tab in an overcrowded browser.

This inefficient setup hits hard in two ways. First, new business policies move fast, and being the first to respond often means winning the client. A slow-moving underwriting process, therefore, directly reduces the chances of success. Second, the costs of collecting, gathering, enriching, and augmenting data become exorbitantly high for each submission.

A central challenge contributing to these inefficiencies is a lack of integration between systems—-information and context do not flow into the right systems at the right. Without a unified system, underwriters are left to handle menial tasks instead of value-adding ones like securing new business.

Going Back to the Drawing Board

These challenges cannot be resolved by simply gluing new capabilities into the existing underwriting workbench. We already have plenty of those—many would argue, in fact, too many. To make the underwriters’ day-to-day tasks painless, they need a more unified experience. A platform approach helps by offering:

Customers today expect quick results, and businesses—particularly in retail and manufacturing—are feeling the pressure. Order management is proving to be a tough challenge due to outdated systems, isolated operations, and diverse applications complicating data management. A typical sales order faces potential errors at many stages, from manual entry mistakes to delays in delivery. These glitches can disrupt the usual order fulfillment process, leading to inefficiencies. Adjustments in product offerings or price changes add complexity, and any hiccup can delay deliveries. Keeping track of each order through its lifecycle is daunting, especially when handling hundreds daily without clear insight into where issues arise in the value chain.

The challenges in order management

Order management is a highly specialized and, quite frankly, complex process. This complexity gives rise to challenges.

These challenges are too complex to be tackled in isolation. A platform-based strategy can effectively address the root causes common to all of them.

How does a platform approach address these challenges?

A platform allows a focus on specific areas while ensuring centralized orchestration of all processes.

Simply adding new capabilities to the existing order management process will not solve the challenges spoken about earlier. There are already too many disparate tools and systems. To make the order manager’s day-to-day tasks seamless, they need a more unified experience. A platform approach helps.

Customers can be unforgiving when it comes to customer service. They demand their interactions with customer service to be quick, efficient, and helpful the first time they reach out. Today’s fast-paced services sector has transformed exceptional customer service into a necessity. In addition, the findings show that nearly 9 out of 10 customers are ready to pay more for a great customer experience.

Customer Service centers are best positioned to address three key customer priority areas:

The potential is obvious, but the ground reality is riddled with multiple challenges that need to be addressed quickly.

Business Challenges in Upgrading Customer Experiences

Envisioning a Game-Changer for Customer Service

To overcome these challenges, enterprises need to adopt an AI-powered platform approach that stitches together the entire user journey by integrating various systems and applications.

Such a platform could easily source the most critical and frequently accessed data to a single, unified dashboard for agents. It could also provide guided workflows to agents that allow them to navigate complex processes with ease. Closing a credit card account or addressing a query about duplicate transactions would happen effortlessly. Both efficiency and compliance with organizational standards would see a tremendous positive uptick. And customers? They breathe easy with consistent and reliable service!

This platform could harness generative AI that uses its Natural Language Processing abilities behind the scenes to personalize communication. Automatic generation of letters, notes, and responses based on the context of the interaction could turbocharge the speed of customer service delivery. AI would ensure that every communication scores high in terms of accuracy and personalization yet is compliant with regulations.