How technology allows us to rebuild the claims journey

Today’s post-pandemic remote and hybrid workplaces have created consumers with higher expectations for technology-driven experiences that make their lives better. As the quantity of health care data increased to 15 times greater in 2020 than in 2013, health technologies and mobile health products have continued to generate additional information, creating a unique opportunity to provide customers with more personalized offerings and care.

When we’re talking about insurance products, this should be no different. Administrators today need to be technologically agile and operationally efficient to make the member experience materially better.

When we think about a member’s benefits journey, arguably the most significant interaction an insured has with their provider — the claims experience — immediately comes to mind. One of the key applications of data discussed in insurance today has to do with how to resolve the various pain points that surround claims by making them easier to file, faster to process and pay, and less burdensome to track and report.

If we leverage medical data responsibly, we can make claims not just painless and simple, but virtually automatic. Here’s why we need to start talking about the potential of claims integration not tomorrow, but today.

What claims integration looks like today

It’s no secret to those in the industry that when it comes to traditional insurance products, claims are unnecessarily complex and cumbersome.

For years, insurance innovators have been finding ways to utilize health care data and make claims simpler. Innovations like ClaimsMinder and Human API are just beginning to unlock the power of data to streamline the notification, filing, processing, and payment of a claim so that employees can get more out of their benefits.

To understand a little more, let’s take a look at what happens when automation is applied through the life cycle of a member’s claim.

Telling the member to file a claim

Often, a member isn’t familiar with the full scope of coverage they have, and therefore may miss out on a benefit payment. In a world where about a third of the population is carrying over $10,000 of outstanding medical debt and nearly half (46%) of insured employees report difficulty affording unforeseen medical expenses, missing out on a benefit can cause unnecessary financial stress.

This is where auto-notification can come in. When armed with electronic medical health records and visibility into recent medical treatment, an ancillary benefit provider can notify a member of their coverage under other insurance products. By analyzing the data of major medical providers, reminders can be sent directly to members when they may be eligible to file a claim for additional benefits, helping employees use their policies and minimize their exposure to out-of-pocket costs.

Submitting a member’s claim

Next, when it comes to filing a claim, members often find the process so lengthy and complicated that they are deterred from completing submission, which can contribute to them not making the most out of their benefits.

With auto-submission, claim administrators can use electronic medical health data to determine that a person may be eligible for benefits, and file the claim for them. It is important to note that when this happens, a claims adjuster may need additional evidence to process the claim, but the automated submission increases the likelihood that the individual receives benefit payments when eligible.

Processing, approving, and paying out a member’s claim

This brings us to our last point in a member’s journey with a claim, and perhaps the most important one: getting their claim approved and receiving a benefit. When electronic medical health data can suffice to automate the processing and payment of a claim, the claim is adjudicated with minimal user input and human intervention from the administrator.

While the industry has attempted to tackle various aspects of such claims integration piece-meal, we still have a long way to go to get to full claims integration that occurs from notification and submission to processing and payment.

Claims integration, when implemented in its entirety, has the potential to build a world where benefits are low touch and high reward. When automation takes place at every step of a member’s journey with a claim, we’re eliminating unnecessary paperwork, delayed claims payments, and most importantly, the stress and worry a member may feel when they’re dealing with a health issue or incident.

The business case for claims integration

While there are clear benefits at the member level, there’s also a strong business case for claims integration for all parties involved. Let’s take a look at some of the network effects when we use data to transform the claims experience.

Member satisfaction drives retention efforts

Members value their benefits when their benefits deliver value. So it shouldn’t come as a surprise that current research shows that faster claims are a major determinant of customer satisfaction for a majority of policyholders. When members have painless, positive experiences with their insurance plan, they’re more likely to feel valued by their employer. In the war for talent. Employers should consider insurance programs that offer claims integration to minimize financial stress, and in turn, maximize productivity and retention.

Employers will gain greater value from funding a benefits offering

When claims integration is at play, more benefits get paid. As a result, employers are more likely to see the value of their contribution to an insurance plan and consider it a meaningful aspect of their benefits strategy with a higher return on investment.

Insurance products with claims integration cut down operational expenses

Using intelligent software solutions to shorten claims processing times can also reduce labor costs and other operational expenses. Claims integration can ensure that data is tracked and documented without unnecessary handholding and manual intervention.

Underwriters can get more accurate, too

Readily available historical claims data can also provide underwriters with valuable information in pricing a group, and its risk, more accurately.

Claims integration gets brokers talking

For brokers, full claims integration in an insurance product has high marketability. This is because it allows them to assure clients that there’s no lost paperwork, and a much lower likelihood of complaints about delayed or absent payments in the event that there are high volumes of potential eligible benefits in a group. With full claims integration comes accuracy and efficiency, which is likely to drive conversations and sales.

 How to harness automation with a human touch

While claims integration in many ways serves to improve the member experience, we can’t forget that at the end of the day, nothing replaces the presence of a human touch.

It may seem counterintuitive, but this becomes increasingly important when we introduce automation to a person’s experience with their benefits. Particularly when we’re dealing with members’ medical data, we can’t forget that these are real people with whom we have to build trust.

 Member support systems should still be in place every step of the way to answer questions, resolve issues, and address concerns. In addition, opportunities for individuals to feel empowered to submit claims proactively and independently must still be made available to account for specific cases where, for example, an automated data file may be scheduled at monthly or quarterly intervals. Allowing the individual to initiate a claim outside of that interval will ensure that benefit dollars are available when they are needed.

When we harness the power of data with a human touch, we unlock the full potential of claims integration, allowing us to offer outsized opportunities for value, minimize financial stress and build long-lasting trust.