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TriTek Solutions specializes in the delivery of customized ECM solutions, providing a wide array of applications and utilities in addition to its extensive portfolio of business services. TriTek offers a suite of foundation software products that incorporate common, universal functionality. This allows focused implementation efforts specific to each customer's needs, significantly reducing the time and cost of implementing customized solutions.
P&C Claims BPM Template
Reduce transaction costs and increase operational efficiencies by streamlining property and casualty claims evaluation and adjudication processes.
Business Challenges
Claims managers are tasked with reducing overall costs, improving service levels and gaining greater control over their processing environment. All this in a business climate wrought with increasing claims volumes, more demanding policyholders and greater compliance stringency. Another challenge for claims managers is the inconsistent application of claims processing guidelines by adjusters, special investigators and even in-house counsel that can result in higher transaction and claim costs.
For those claims managers still dependent on a manual claims processing model, their challenges are more difficult as they strive towards a streamlined, more automated processing model. It is also difficult to track claims and requests for additional information required for adjudication. Consequently, carriers can experience increased inquiries to their policyholder service departments as claim statuses must be manually researched; requiring a significant time investment.
A manual claims processing model prevents carriers from implementing rulesbased workflows to achieve consistency in applying policy guidelines.
Performance reports are manually created from log reports completed by claims adjusters. Work is distributed physically to claims adjusters using bins, folders or stacks. Without real-time transaction statistics for the number of claims and actual employee productivity, managers cannot fully implement load-balancing of work. Faced with increasing regulatory requirements to protect claims information, managers are unable to guarantee compliance and might be subject to fines as a result of unauthorized access to or distribution of claims information.The nature of some manual claims processing environments requires that claims data is manually keyed from paper into legacy systems. In addition, the legacy data might also be difficult to access which can mean the difference between claims being paid in error versus being denied. Often companies can incur high transaction costs due to these inconsistent operational practices.
The Solution
TriTek's P&C Claims template allows claims managers to implement a claims adjudication methodology using the structured management of claim-specific content along with associated in-house processes. This solution enables the delivery and processing of claims in an online environment customized to the requirements and business rules of each carrier's claims operations. Claims managers can dramatically reduce claims processing costs with the structured distribution of work, integration with legacy systems and efficient management of exception processing. Using the P&C Claims template's real-time audit logging and performance metrics, managers can closely monitor their service teams, make ad hoc adjustments, eliminate processing bottlenecks and deliver improved customer service to their policyholders. For example, customer inquiries as to the status of a claim are immediately fulfilled by querying the system for transaction-specific data.
With all claims and related supporting documentation imaged, claims processing is completed entirely online. The P&C Claims template uses a queue-based framework to organize work by task and claim type. Work is automatically distributed to adjusters based on the claim status, transaction type and/or specific processing requirements.
Transaction types and claim content supported by the P&C Claims template include indexing, medical review and processing, estimate review and processing, subrogation, and claimant correspondence. For each of these transaction types, the solution provides a customized user interface and integration to legacy systems via an open architecture. Staff members in the back-office have access to the transaction-relevant collection of content and the legacy processing environment. The P&C Claims template is integrated with some of the most popular claims management and underwriting systems.
Claims managers gain a significant amount of administrative control and performance metrics with the P&C Claims template. Through the user maintenance utility these managers can specify processing requirements for any of the system users and assign or remove user access to/from any system queue. Managers can designate work based on custom defined criteria (work volumes, user skills, transactional priorities, etc.). The solution's customized reports provide managers with the ability to view every action performed within the system from both a user and system perspective in a relational database format, allowing further analysis of any subset of the data or even viewing the data using Excel or via customized Web pages.
Value Proposition
The P&C Claims template leverages the value of leading Enterprise Content Management (ECM) and Business Process Management (BPM) technology in managing content and process. It provides P&C carriers with the ability to reduce claims transaction costs and processing times. In addition, claims adjusters can gain immediate access to all data relevant to the claim online. The solution eliminates the need to manually enter data into legacy systems. It streamlines the processing environment with a common interface; yet can also be customized to defined processing parameters for specific transactions. Manual ad hoc processes are also eliminated with its automatic tracking and categorization of incoming content. Customer service representatives are able to provide real-time status updates to policyholders.
For more information
To find out how our Industry Templates can speed up your BPM solution implementation, contact us at products@triteksol.com