Transforming claims processing

Summary:

Transforming claims processing

Challenge:

With the existing claims process based around a mainframe system and paper intensive environment, the company had launched an initiative to develop an efficient claims processing system. This needed to be integrated with a Customer Relationship Management (CRM) solution that would provide a common customer view across agents, call centers and claims. This in turn would help the company improve the quality of customer interaction, target offerings and utilize cross selling opportunities.

User and agents use the claim processing system to log claims on behalf of customers and track their status. However claims submitted for closure are sometimes delayed because of inaccurate or missing data during the claims entry process. With a need to ensure faster resolution of such issues, the company invited Wipro Technologies for the production support of the system.

Solution:

Leveraging the Global Delivery Model, Wipro provides daily production support, emergency change request and Trouble Ticket (TT) resolution based on established Service Level Agreements (SLAs). This model consists of a Wipro team based at the client’s facilities working in coordination with a team located in the dedicated Offshore Support Center in India.

AppGuru was involved in this project from the proof of concept stage and evaluated tools in the areas of CRM workflow, imaging, document management and document storage. A comprehensive CRM solution around Siebel was implemented with key features like:

• Computer Telephony Integration (CTI): Call Center operations were modified using CTI to enable features like routing of calls to the smallest queue and automated answering.
• Automatic assignment and alerts: An automatic outbound paging system triggers a message to the concerned Field Call Representative. Claims can also be escalated automatically to superiors.
  

Benefits:

• Integration of the legacy system with CRM and work flow management tools resulted in better process handling and improved customer service
• Automation of the claims processing system resulted in seamless connectivity of all personnel/multi channels involved. This included call center, field representatives, claim adjusters, office claim reps, salvage yards and towing agencies.
• With the web-enablement of claims processing, services from submission of claims to queries on claim status can be effected online
• The client can address their customers’ claims faster and more efficiently because of speedy resolution of issues
• Various tools have been developed to automatically fix issues and root cause analysis carried out to minimize creation of problems
• Cost reduction for legacy systems maintenance and production support leveraging the global delivery mode

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