Open Text claims management

By David Arni, Industry Solutions Manager EMEA

Improve Claims Management Processes for Insurance

The Business Challenge

In today's diverse claims processing environment, insurance companies are facing many challenges: increasing paper handling costs, stringent regulatory compliance requirements (Solvency II), processing inefficiencies, transaction cost controlling, improving customer service levels, and many more. In order to remain competitive, insurance companies must be able to handle customer requests cost effectively and increase customer service levels. To do this, they need Enterprise Content Management Technologies that allows them to automate and streamline business processes in order to eliminate inefficiencies and provide a better customer experience.

The limits of traditional claims processing

Insurance claims processing has traditionally been a paper-based, labor intensive, repetitive and manually orientated process. Multiple steps and approvals are required to complete claims transactions, increasing the costs and time required to complete each transaction. In addition, reporting and controlling is inconsistent or difficult to implement in a predominantly manual process. On the other hand the risk of being non-compliant to external regulations is very high. 

Solution Overview

Enterprise Content Management solutions from Open Text solve many of these challenges by adding capabilities to support the most effective use of all enterprise information resources. To address the problem, it's important for organizations to establish a clear Enterprise Content Management strategy. Incorporating document processes into business processes is not a new concept to insurance companies, but clearly one which hasn't been tackled successfully with a standard approach. By digitizing content early and creating digitized customer / claims folders, insurance companies can accelerate and potentially reduce their claims process costs, eliminate legal inconsistencies as well as enhance customer communications throughout the customer lifecycle.

A Step by Step Solution

In a digital mailroom solution all incoming document oriented data sources on paper, fax, email are captured, digitized, analyzed and then forwarded to the next process step electronically. This means that a series of tasks can, and should be, automated. Reconciliation with databases, plausibility checks, and other functionality such as collaboration support for claims exception handling can also be incorporated.

Once a claims process is started, the Workflow Management System produces a task list for the claims officer, distributes the claim details and task requirements to the appropriate employees, prioritizes each task and keeps track of each tasks status until completion. The synchronization of people and processes improves the throughput of claims processing. The Workflow Management System allows multiple users to perform parallel activities on a claim and provides the possibility to engage external people (e.g. surveyors) in the process. It automates key tasks, tracks process cycle times, and obtains qualitative management information for setting and validating claims processing goals.

In addition to a digital mailroom, a digital claims file provides further transparency in customer communication  by allowing multiple clerks to access a customer folder simultaneously. Furthermore, the ability to easily search for claims and other customer documents online and the elimination of the need to duplicate claims files improves daily task handling. Customer Services Representatives can see the interdependencies between claims and customers more easily and, as a result, make accurate decisions faster. In the case of a clerk's absence due to vacation, sick leave, or staff turnover, all customer files can be easily reassigned and requests can be handled without interruption. There is a higher degree of customer satisfaction and retention due to faster service and better communication.

The big advantage for this end-to-end ECM solution from Open Text that starts at the beginning with capturing external information (digital mailroom), business process control, collaborative exception handling and at the end of the claims process (a complete claims file is available). This means that right from the beginning of the process in the mail room customers have a complete overview, a fully controlled audit mechanism for compliance purposes and access to all the required information to enable them to handle the claim fast and efficiently.

Other Solution Advantages

Integration with existing insurance business applications is important so that claims officers can work in a familiar environment. Open Text Enterprise Content Management solutions are based on open standards and common technologies that can be integrated into existing customer environments. In particular, integration with industry leading solutions such as SAP Insurance is already in use by many existing customers in Europe. This increases the cost benefits of the solution further as claims officers have access to all relevant documents directly from their SAP Insurance environment and workflow processes are also fully integrated. Workflow processes can be extended beyond the insurance application to the web or Microsoft Outlook to perform, for example, approvals for the next process step.

The finance industry is increasingly under pressure to meet legislation and legal compliance directives from the EU. How does Open Text Enterprise Content Management help you with this? The digital mailroom and claims/customer file solutions are underpinned by the Open Text Enterprise Archive system that stores all digitized documents and maintains an audit trail of the business processes. With the Open Text Archive System all data and documents are stored legally and securely, thus fulfilling legal and compliance requirements for SEC 17.4a, DOD 5015.2, Solvency II, Basel II, PDI DSS etc.

Benefits

Scanning, digitizing and forwarding of all documents electronically within a digital mailroom can save processing time. Seamless integration with existing insurance application environments during workflow processes and with the digital claim and customer folder optimizes internal and external business steps enhancing customer service levels and information quality. Ensuring compliance and providing instant access to the relevant documents throughout the organization - both for daily use and in the event of an audit request, reduces process timing, operational costs and provide full legal compliance.

Next Steps

Please contact your nearest Open Text office for further information about our solutions for claims processing and to have the chance to talk to an existing customer who is already benefitting from these solutions.

Or send us an email to: financialservices.emea@opentext.com.

For information on other Solutions please click here http://www.opentext.com/2/global/sol-industry/sol-ind-insurance.htm