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Automation for Processing Insurance Claims
Many processes within the insurance industry rely upon both legacy systems and newer applications and technologies. From underwriting to billing, from risk management to policy administration, automation can streamline these processes for higher employee output and improved policyholder experience.
With Claims Processing being an ideal candidate for RPA in the insurance industry, let’s walk through how OpenBots Studio can be used to automate this process.
Andrew is a claims processor at a national insurance company. It can take him 15 to 40 minutes to process an individual claim and it is common to have a backlog of pending claims, causing long wait times for policyholders to receive their money after submitting a new insurance claim.
Before using OpenBots RPA, Andrew would receive claim forms as PDF documents via email, transfer the forms into a queue folder, compare the data in each claim to the policyholder’s account to make sure they match, then manually copy policyholder information into the claims system for each submitted claim.
With OpenBots Studio, Andrew receives the claim form via email, just as before. But rather than processing the claim manually, he opens all programs needed to perform this process and runs his OpenBots automation.
The Bot opens the email and saves the claim form PDF to the queue folder, then goes into the queue folder and opens the oldest claim in the queue. The Bot reads the policyholder’s account number and locates the matching account in the company’s system, then compares the information. If there are discrepancies between the account and the information in the claim, the Bot saves the claim to an Exceptions folder for Andrew (the human claims processor) to review.
If there are no discrepancies, the bot copies all of the claim information into the company’s claims system and attaches the PDF. The bot then sends an automated email to the payment processing unit notifying them that the claim is finished and ready to be paid. Afterwards, the Bot moves on to the next claim in the queue and repeats the process until all claims in the queue are complete.
The Bot processes the oldest items in the queue first, eliminating the backlog problem and ensuring the policyholders receive their money in a timely manner. Before using OpenBots Studio, Andrew and the other claims processors would have to manually enter information like policyholder’s name, claim number, date of birth, address, SSN, and other data into the company’s claims system as the queue continued to grow. Now, Andrew and the other processors can focus their efforts on reviewing the items in the Exceptions folder to fix any discrepancies between the claims and their associated accounts.
Compared to the 15 to 40 minutes it took Andrew to process a single claim, it takes the OpenBots Studio automation only 3.5 minutes on average to process a claim.
