Client Background
颁濒颈别苍迟:听An American healthcare products and insurance company
贬别补诲辩耻补谤迟别谤蝉:听Minnesota, USA
Legal Status:听For-profit managed company
贰尘辫濒辞测别别蝉:听+300,000
The Challenge
Slow, inaccurate claim validations were increasing customer attrition, inflating costs, and draining revenue streams.
- Multiple legacy claim systems
Several different business areas were running on outdated systems. - Inefficient processes and communications
Certain business areas were using SharePoint, emails, and manual spreadsheets to manage claim submission and validation. - Lack of standard knowledge base
Assistance for claims agents was inconsistent. - Limited visibility
Oversight of agent and team performance was limited, especially on the organizational level.
The Solution
91快活林 proposed a comprehensive CSM-based solution with flexible, modernized internal systems.
- Standardized claim submission and validation process through one system and one architecture, across all the business areas
- Dynamic, automatic workflow orchestration听Single product prioritizes workflows and routes them to agents based on skill and availability
- Automated productivity tracking听Personalized dashboards and reports
- Enhanced claim processing听Alert and escalate requests based on SLA and OLA
Business Impact
- Customer satisfaction听Improved with more efficient claims validation
- Productivity听Increased with greater visibility, and automated prioritization and routing
- Operational efficiency听Increased with greater visibility of agent productivity, aiding in capacity planning and forecasting
- Revenue streams听Restored and leaks mitigated by reducing the number of false claims processed through standardized approval processes
