Skip to main content

Intelligent process automation

Eight big impacts for insurance claims processing

In a world where technology advancements are happening at lightning speed, many insurance claims processing environments are still navigating lingering challenges like manual processes and paperwork; legacy systems and integration glitches; data security and privacy issues; customer demands for speed and convenience; fraudulent claims and regulatory compliance.

As technology continues its rapid advancement, the risks of not addressing and overcoming these challenges only amplify over time — inefficiencies expand, scalability is constrained, error rates increase, data accessibility and analysis are limited, and costs grow. Meanwhile, customer satisfaction and business performance suffer.

Conquering these challenges is critical to enhancing claims processing efficiency, remaining competitive, mitigating risks, improving customer experiences and excelling into the future.

The next-gen of next-gen

Intelligent process automation (IPA) combines and builds upon the power of artificial intelligence, machine learning and workflow automation to supercharge digital processes.

IPA takes the powerful benefits of AI, ML and RPA to the next level — coupling automation with advanced decision-making, adaptive learning, cognitive capabilities, predictive analytics and sophisticated integration.

Leveraging these cutting-edge technologies, IPA empowers process optimization, innovation and transformative results. IPA integrates seamlessly with existing systems, applications and workflows to orchestrate end-to-end processes across the organization. By connecting disparate systems and data sources, it can streamline processes, automate handoffs and ensure data consistency and integrity.

Because of that, IPA is poised to come to the rescue for organizations — catalyzing claims processing modernization, advancing digital transformation initiatives and accelerating innovation across the enterprise.

Eight big impacts IPA can have on claims processing:

  1. A turbocharge to efficiency: IPA takes automation to new heights —fueling rapid, high-efficiency claims handling, streamlining workflows, reducing manual efforts and expediting the settlement process. This case study spotlights how a variety of intelligent technologies supercharged enrollment processing for a major health plan, boosting field-level automation to 80%.
  2. Significant cost savings: By minimizing errors, reducing the need for manual labor, optimizing resources and accelerating operating efficiency and productivity, IPA reduces costs. That translates to better financial performance for an organization. Savings estimates from intelligent automation range from 25-75%.
  3. Accuracy and compliance: Precise execution of automated tasks, error-free form translation and seamless ongoing monitoring and maintenance of regulatory compliance all safeguard against risk and build ongoing reliability.  One example of this valuable functionality is the automated identification of appeals requests, which carry stringent industry-imposed penalties when not reviewed and dispositioned in a timely matter. Using intelligent document processing techniques to detect language and sentiment in healthcare documents that may indicate an appeal or expedited appeal, payers can increase member and provider satisfaction while avoiding significant penalty costs.
  4. Data-driven decision-making: While RPA focuses on automating repetitive tasks, IPA incorporates AI and ML algorithms to analyze data, recognize patterns and make decisions. This means IPA can not only execute tasks but also make intelligent decisions based on contextual information, historical data and predefined rules. Leveraging advanced decision-making capabilities, IPA can handle more complex and dynamic processes, further improving efficiency and accuracy.
  5. Elevated customer experience: IPA allows a level of service that goes beyond expectations. Claims can be processed with unprecedented speed, reducing wait times from days to hours or even minutes. Automation minimizes errors and inconsistencies, ensuring claims are handled accurately and fairly — enhancing trust and satisfaction among customers, further strengthened with instant or ongoing notifications at every step of the process.
  6. Predictive analytics: IPA leverages predictive analytics capabilities to analyze historical data and patterns, forecast future outcomes or customer behaviors, identify trends and anticipate potential issues or opportunities. By, IPA can predict future events, such as customer behavior, market trends, or operational performance. This allows organizations to make proactive decisions, optimize resources, and mitigate risks, leading to improved business outcomes and competitiveness.
  7. Adaptive learning: Unlike traditional automation solutions that follow predefined rules and instructions, IPA systems can learn and adapt to new scenarios and changes in the environment. ML algorithms enable IPA to analyze data, learn from experience, and continuously improve performance over time. This adaptive learning capability allows IPA to evolve and optimize processes autonomously, leading to greater efficiency and effectiveness in operations.
  8. Cognitive automation: IPA combines automation with cognitive technologies, such as natural language processing (NLP) and computer vision, to mimic human-like cognitive abilities. This enables the technology to understand unstructured data, interpret complex information and perform tasks that require human-like reasoning and judgment. By incorporating cognitive automation, IPA can handle more diverse and cognitive tasks, leading to increased productivity and scalability in operations.

IPA is set to unleash a new era for insurance claims processing. By embracing this revolutionary advancement, organizations can transcend the limitations of legacy systems and manual processes and usher in a future of high-efficiency, high-performance operations with consistently positive customer experiences.

Read more about intelligent technologies in our related eBook: Intelligent Document Processing: The cutting-edge technologies powering the future of business.

And learn more on our website about Conduent Automated Document Solutions.