Healthcare—of which health insurance is an integral part—is a sector that represents a significant financial concern for the United States. Findings from the 2019 CAQH Index report cite the US to be the biggest spender among any other developed nation when it comes to healthcare and administrative services. The area of claims, in particular, has long been a money drain on health insurance providers. Claims status inquiry alone is the second most expensive transaction for the medical industry to conduct, and slow and inefficient claims processing systems on the part of insurers account for billion-dollar losses every year.
The gradual digital transformation of the insurance sector, however, has brought about renewed hope in the areas of claims processing and claims management. With the variety of technological solutions available to them, insurers have the opportunity to improve upon their claims processes and attain high savings potential on their claims spending. They may also use the revamp of their claims processing systems to put their best foot forward in front of their customers and cultivate greater esteem for their respective insurance brands.
As a constituent provider in the insurance industry, your company will also change for the better when you join your peers in their digital transformation and shift to a health insurance solution for claims processing. To give you an idea of how you can expect your claims processing to improve, here are four key benefits to the digitalization of your claims system.
It Will Lower the Cost of Addressing Every Claim in Your System
Claims are expensive for health insurers to handle because they demand a lot of resources in terms of time, energy, and manpower. Many legacy systems for handling claims are also burdened with a number of upstream complexities, which make the downstream processes harder for staff to resolve and make them more vulnerable to costly claims-related errors.
After deploying a new solution and shifting to a digital system for claims processing, you will likely notice a marked improvement in your overhead costs for handling your claims. More efficient use of time and energy will translate into a lower cost of resolving each individual claim. The difference may seem small at first, but soon your company will enjoy the fruits of long-term savings on this particular expense.
It Will Utilize Automation to Make Your Staff More Efficient at Claims Processing
The second great advantage of shifting to digital claims processing is the opportunity to implement automation technologies in claims management and claims resolution. The use of automation capabilities for real-time claims adjudication, authorization, and referral management will improve your performance at claims processing, ultimately resulting in a faster and more accurate claims system.
In addition, by using the automation technologies that come with your new digital claims processing system, your insurance staff will be empowered to work smarter instead of expending all their energy on rote claims-related tasks. They will also be less overwhelmed about any influxes in your claims system, for example, due to the expansion of one of your health insurance product lines.
It Will Cultivate Smarter Spending and Billing Practices through Agile Claims Pricing
Though it is easy to understand that claims processing can be costly, some insurers might not be exactly sure where to ascribe those costs and how to reconcile them. Part of the answer may lie in getting a better handle on claims pricing. An insurer who can be agile about implementing several different claims pricing methods—with each one responding to the circumstances of each case—has a bright future within this increasingly tech-driven and competitive industry.
One of the first things you should do in your quest to revamp your claims processing is to run a flexible claims pricing system. The ability to instantly verify contracts and pricing clauses, calculate different prospective or retrospective payments and enable provider payment for different conditions will be a welcome improvement to your insurance services indeed.
It Will Give You Better Insight on Your Claims System through Claims Analytics
The best digital insurance solutions also come with superior data analytics capabilities, and for sure, you will be able to use these to derive insight into your claims process. The analytics functions on your digital system will allow you to get a bird’s eye view of your claims situation, including what types of claims are most prevalent or where backlog tends to build up.
In the long run, it should be the goal of your company not only to improve its performance at resolving individual claims but at making macro-level decisions that will affect your whole claims system. You will only be able to do this with a complete, data-centric picture of your claims processes, which a fully digitized system will attain for you.
Towards Enhancing Your Customers’ Overall Claims Experience
Ultimately, the shift to a fully digital claims processing system will do three good things for your insurance company: it will save you money, it will help you modernize your insurance services, and it will enhance your customers’ experience of your brand. The last item is something that deserves special attention, as claims form a big part of your customers’ overall impression of your service. Ensure that you have their trust in your ability to resolve claims—and distinguish your company as their insurer of choice—by modernizing your claims processing system.
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