Claim CRM
No means of automatic control for claims resolution
Problems with system accessibility, responsiveness, and performance
No automatic task routing, tasks assigned by a manager
No end-to-end task queue, no pipeline mode of claim processing with automatic prioritization
Reimbursement approval process is carried out through the Accounting outside of the system and is difficult to monitor
Data duplication for different back-office systems, and as a result, inconvenient manual search against several archive databases
Claims Processing Automation: Development of an Omnichannel Claim Processing Automation System
Establishing an effective automated claim processing mechanism
Increasing client loyalty thanks to to reduced claim processing time
Replacing current solutions based on Lotus Domino and MS Access platforms
Improving employee efficiency thanks to back-office systems integrations as part of a single workspace
The solution has been in operation since 2016.
It is a single entry point for all claims from corporate and private customers and also for both clients and non-clients.
Built an MVP for the multiple claim types received via a single channel
Expanded solution feature set, added new service channels and new claim types, performed integrations with back-office systems
Removed obsolete systems from service, and added new claim types. Enhanced automation level, added new integrations
SOLUTION HIGHLIGHTS
- Workplace is a convenient user portal with all basic features necessary for claim processing
- The home page contains a personal employee task list, division tasks, reports, resolved claims, client and claim search
- Claims are distributed according to the business rules of the system to divisions that have the necessary competencies to resolve them
- Each employee can view the task list of the bank division, select a task and start working on it
- Employees can track the deadlines on claims resolutions and back up each other during high workloads
- The system has a catalog of typical corporate and private clients’ claims
- There is a business rule for each claim type that routes claims to a specific bank division
- This approach allows to re-distribute the workload of divisions responsible for the claim processing, differentiate specializations and eliminate manual claim distribution
- A draft can be created for those claims that can’t be processed fully automatically
- A draft is a claim with a specific type that is created manually. Employees process such claims manually using adjacent systems in separate windows to conduct operations
- Eventually each draft becomes more automated eventually and can be processed more quickly within a single window
- If a claim implies a refund from the bank and the refund has been approved, the employee calculates the reimbursement
- After the calculation has been completed, the employee creates transactions for the bank to complete the claim processing
- The system logs all manual and automatic events within claim processing
- The audit is indispensable for cases when the analysis of false operation is required
- If there is a need to route tasks according to specialization, it can be achieved with special attributes that are assigned to each employee and which means the employee is a specialist in a particular area
- Thanks to this employees can process only those claims that are related to their competencies
- A convenient instrument for a parameter and account details search that allows to find the client within seconds, look through the claim history and form an appropriate resolution on the new claim
- Several types of reports are available: client segments, processing status, claim types, employees, and reimbursement reports
- A quick and convenient claim search allows to find any claim and check the processing details and history
- If a client asks to respond on a previously created claim, it is possible to check the history and provide all the necessary information
RESULTS
Built a single omnichannel automated client and non-client claim processing mechanism
1Improved employee productivity and efficiency thanks to back-office systems integrated into a single workspace
2Increased client loyalty due to reduced claim processing time
3Obsolete solutions based on Lotus Domino and MS Access platforms were removed of service
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