rules, to drive the processing of the claim
from the top level down to the most minor adjudication task. Unified policies
and procedures further this capability by
enabling a “channel agnostic” claim intake
strategy and seamless handoffs to the optimal claim resources. Business rules ensure that adjudication steps, assignments,
service level agreements (SLAs), and so
forth are processed in the same manner
and tracked at both the claim and sub-task
By eliminating the need for custom coding and the
need to maintain multiple versions of a single process,
insurers gain business agility that facilitates rapid ROI.
level. With an intelligent system managing
the process steps that need little or no human intervention, insurers can automate
low-complexity claims or claim activities
to better contain costs and achieve gains in
efficiency and productivity.
3 Maximize the impact of the claim
value chain. By combining rules and process with case management, insurers can
manage the orchestration of a complex
claims process across multiple systems,
analytic tools, data stores or third-party
services. This unique capability allows insurers to marshal the right resource at the
right time in pursuit of the best case claim
outcome. Because BPM provides rules-driven processes, insurers no longer have
to rely on adjusters to be the key drivers
of the claims process. Instead, automated
case management can be easily integrated
with back-end systems, accessing and using appropriate assets in real-time as part
of the streamlined process.
4 Convert insight to action. Increasingly, insurers are driving improvements in
service or operations results by incorporating business intelligence and analytics
into their claims management processes.
However, many insurers are just beginning to scratch the surface and have yet to
realize the full potential of this capability.
In addition, while the insight these tools
provides is high value, many insurers lack
the means to turn that information into
the next best action. Insurers need claims
solutions that can help them gain greater
leverage from analytics by making them
actionable. With BPM solutions that embed analytics within the claims process,
insurers can use business insight in real
time, such as fraud scores, settlement
potential, churn risk, and more to drive
the next best action in the claims process.
This allows insurers to invoke the right
processes to actively address any claims
issues and remediate potential risks.
5 Create a competitive advantage
with strategic reuse. To reduce costs
throughout claims operations—and the
enterprise—insurers need to share best
practices across the entire claims organization. This requires the ability to make
changes holistically to all of the processes used to manage claims. With a unified
BPM solution that provides a common
repository of claim-specific policies and