INSURANCE Claims Processing Automation
Context
The claims procedure is one of the essential operational processes for an insurance company. The process begins with the client notification about the damage and continues with steps as such aligning with checking the beneficiary and insurance policy or multiple policies, validating the type of event coverage, medical validation, possible fraud detection, going through the payment file approval process, generating payment files and closing files. Throughout this process, the insured person and various actors must be notified according to the status of the file and the related information accumulated as a result of the file workflow from one actor to another. In addition, the process is not meant to be linear but branched according to the diverse parameters of the file (policy type, event type, payment amount, and other variables). Last but not least, the platform must integrate the core business systems, the DMS, banking systems, and accounting applications.
Challenge
BCR Insurance was using for its claims processes an IT architecture combining the individual email reception with manual (human) processing and verification of requests in the core systems, manual generation of payment files and those needed for opening bank accounts, and email transfer of information to third parties (e.g., doctors). As a result of the clients’ number growth, so did the challenges that occurred:
- Long closing times (of files) – manual checking of the core system policies, email communication between the actors of the process, manual generation of the files, and the complexity of the process arose an increase of the processing time of the requests, especially in the case when the client was not submitting all documents required from the beginning;
- Operational errors – as the increase in demand of processes is part of the daily operations, so their manual interpretation and their transfer of documents via email, the processing margin error and implicitly the number of re-submitted files within the workflow after verification;
- Poor client communication – before the implementation, the client was informed only when exceptions were to be discussed, not having a clear status of the file or the steps tracking within the process
- Reporting and monitoring difficulties – every file’s timeline and the aggregated and complex reports given within the process were hard to obtain and need manual processing. Moreover, a real-time situation, whether aggregated or specific (per file), was difficult to obtain.
The chosen solution
The chosen solution was Encorsa’s custom application implemented by two low-code technologies: a BPM platform incorporated within the internal workflow, supplementing the RPA robots, operating within the core system’s data. The communication within the core systems and the third parties’ systems is to be done throughout the API or, in the case of legacy systems, the RPA robots. The email messages transmitted to clients are taken over automatically by the system, and its claims file is initiated and allocated by the consultant.
The system automatically communicates with the core system, thus permitting the validation and the check-up of the policies, the generation of bank files, and the payment papers. The client is notified as soon as the status of the file is changed. In addition, the approval and audit mechanism are incorporated within the platform aiming at a coherent and fast unroll of the claim validation process.
Benefits of the implemented process automation platform
As a result to the implementation of the automated claim process platform, there were obtained the following benefits:
- Simplified operation and its speed
- The BCR Insurance operator is not following a series of software applications, instead is having at hand a single interface visualizing and operating all information needed in the claim;
- Calculation of sums are automated by the system depending of the parameters;
- The doctors are directly involved in the completion of necessary info;
- File generation are automatically processed for third parties;
- Real-time feedback
- The client is notified automatically depending on the actual step (status) of the policy;
- Predictability and control
- The advanced traceability of the file is possible with the real-time check-up of the actual status (workflow step), operation linking the time and user involved;
- Digital File storage in Repository is automated.
About BCR Insurance
BCR Life Insurance is an enterprise member of Insurance Vienna Group, one of the most prominent international insurance groups of the central and eastern EU. Established in 2005 as a BCR subsidiary, the company began its activity in 2006. In the same year, ERSTE Group becomes the lead shareholder of BCR, thus BCR Life Insurance ranking as a direct result in the top 10, more precisely the 8th place of Romania’s life insurance company. In 2007, the enterprise was also authorized as the administrator of the optional pension, further launching their first founding and becoming the industry leader. In September 2008, Vienna Insurance Group (VIG) became the prime shareholder of the company, thus the enterprise gaining a new logo. Starting with 2009, the company becomes the market leader in life insurance and occupies the second position in this industry. Client orientation, constant adaption on the market, innovation, development of distribution channels, and the attention to employees gained the company the title of “Company of the Year” four times in a row.
Conclusion
Using an agile methodology, the BCR Insurance team, in collaboration with Encorsa, succeeded in developing a custom automated platform of claim processes adapted to the client’s needs in only 6 months. In addition, the platform enabled the acceleration of the files solving process, error reduction, increased operational efficiency, real-time feedback for both clients and management, and the integration of the company’s core systems. Moreover, soon, every adaption of business workflows can be done faster, allowing the change to be done more agilely regarding the challenges given by the external business environment.
