{"id":15162,"date":"2021-01-25T19:23:32","date_gmt":"2021-01-25T13:53:32","guid":{"rendered":"https:\/\/cigniti.com\/blog\/?p=15162"},"modified":"2022-07-28T19:46:36","modified_gmt":"2022-07-28T14:16:36","slug":"qa-ai-rpa-automated-claim-adjudication","status":"publish","type":"post","link":"https:\/\/www.cigniti.com\/blog\/qa-ai-rpa-automated-claim-adjudication\/","title":{"rendered":"Quality Assurance for Insurance: Getting Automated Claim Adjudication right, the first time"},"content":{"rendered":"

The global pandemic not only was a health scare \u2013 it also led to a lot of economic distress. While Insurance companies in such times play a critical role in providing a cushion and help organizations manage the risks, they too have been under tremendous pressure. Not only are they subject to the volatile financial markets, they also need to adjust to the new norm – and yet be successful in their venture.<\/p>\n

Per a study by Coforge, \u201cThe Insurance carriers have lost roughly 48% of their market value since the crisis commenced; with life & health insurance carriers particularly hit hard with average drops of 58%. The cost of COVID-19 testing and treatment is likely to squeeze U.S. health insurers’ profits, which could lead to higher premiums in 2021.\u201d<\/em><\/strong><\/p>\n

Changing times and customer needs require technology adoption<\/strong><\/p>\n

The business imperatives and the changing customer needs have made it critical for insurers to embrace disruptive technologies such as Blockchain, AI and IoT. Digital transformation is no longer a choice for them, and one must use these technologies across the value chain for enhanced brand differentiation and higher profitability.<\/p>\n

Most of the QA programs often take a back seat when choices are made for the future course of technology transformation. Organizations that show agility and a commitment to constantly unlearn and learn from the experience will reap benefits as they tread along the digital transformation journey. Those who decide to bide their time and remain cautious will be at a risk of being left behind.<\/p>\n

With the pandemic spurring on the need for digitalization, accelerating the adoption of automation has become critical in the role of the claim handling and adjudication process, a vital aspect of insurance companies.<\/p>\n

Quality Assured Automation of Claim Adjudication<\/strong><\/p>\n

A bad claims experience can lead to almost 84% of the insured and proposers change their insurer. This is an alarming enough rate to emphasize the importance of automation and customer satisfaction during the claim adjudication process.<\/p>\n

Not only does a traditional claims processing take many days due to manual intervention and a lot of paperwork, there\u2019s also the challenge of even small errors such as a misspelled patient name that can cause a claim to be rejected.<\/p>\n

How can insurers adapt to their customer demands whose needs, knowledge and expectations have expanded exponentially? The customers naturally want their problems to be addressed fast, and an organization that can achieve this is going to put itself in the driver\u2019s seat.<\/p>\n

In an age where customers voice is a critical mode of improving \u2013 or spoiling one\u2019s reputation, insurers must understand that there is a need to adapt to the new demands in the digital era. It is imperative, thus, that the claims are submitted electronically where the software can help prevent errors before it is submitted for payment.<\/p>\n

This is where automated claim adjudication comes into play.<\/p>\n

Quality Assurance is key for Insurance companies to gain the trust of their customers, and to run their business seamlessly without any hindrance. Getting the automated claim adjudication right for the first time is what the insurance companies should vouch for.<\/em><\/strong><\/p>\n

To automate any segment in the Insurance sector, organizations need to emphasize on 4 major factors:<\/p>\n