Claim Operations Optimization

Processing claims quickly and accurately is one of the biggest challenges payers face today. Huge volume of claims notwithstanding, multiple and incompatible systems requiring significant manual hand-offs have made the timely disposal of claims the single biggest burden on payer operating costs. Add to it the problem of incorrectly filed claims that require re-processing and the problem suddenly becomes even more acute. With state specific regulations penalizing such delays, payers must figure out the optimal trade-off between analysis one claim warrants versus time it takes to get it through the system.

Given this alarming rate of errors and delays in processing, payers are working relentlessly to improve efficiency through automation. However, in our experience a lot of such well- meaning initiatives fail due to lack of thorough understanding of various linkages across the claims processing lifecycle. In our view claims processing is not an operational problem, it’s a dimensionality reduction problem. In this paper we present a detailed discussion of the claim processing lifecycle, its typical challenges and our proprietary technology platform. A disguised client example is used to demonstrate the intuitiveness and simplicity of this framework.

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