Overview: A major health insurance company aimed to improve their claims processing efficiency and customer experience by adopting digital innovation through Appian BPM.
Challenges:
- Manual Processes: Claims processing was largely manual, leading to errors, delays, and dissatisfaction among customers.
- Lack of Visibility: Lack of real-time visibility into the claims process made it difficult to track progress and manage workload.
- Complex Workflow: The claims process involved multiple steps and departments, making it prone to bottlenecks and inefficiencies.
Solution:
- Process Automation: Appian BPM was used to automate the claims processing workflow, reducing manual intervention and minimizing errors.
- Unified Platform: Appian provided a centralized platform where claims could be submitted, tracked, and processed seamlessly.
- Rule-Based Decisioning: Appian’s rules engine was utilized to make automated decisions on straightforward claims, expediting the process.
- Integration: Appian integrated with existing systems and databases to pull necessary data and documents, creating a unified view of each claim.
Results:
- Efficiency Gains: Claims processing time reduced by 40%, leading to quicker reimbursements for customers.
- Improved Accuracy: Automation significantly lowered the error rate, improving customer satisfaction and reducing rework.
- Enhanced Visibility: Real-time dashboards allowed supervisors to monitor the workflow, allocate resources, and identify bottlenecks.
- Cost Savings: Reduction in manual effort and errors led to cost savings, positively impacting the company’s bottom line.
