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The Business Leader’s Guide to Claims Process Automation

The insurance industry is increasingly turning to automation as a way to improve claims handling and decision-making. But insurance companies aren’t the only ones who can benefit from insurance claims process automation. No matter what industry you’re in, you can use automation solutions for claims management in order to reduce processing times and accelerate the digital transformation of your business.

Here’s what businesses need to know about insurance claims process automation, and how you can use insurance claims analytics to make better business decisions.

What Is Claims Process Automation?

Claims process automation involves using technology, such as artificial intelligence (AI) and robotic process automation (RPA), to streamline key parts of the insurance claims process. It’s commonly used in the insurance and healthcare industries to save time, reduce human error, and eliminate time-consuming manual tasks.

Here are just a few of the automation tools used in claims process automation.

Robotic process automation

Robotic process automation (RPA) is a type of business process automation (BPA) that uses simple programs called “bots” to perform repetitive tasks such as data entry and form-filling. These bots aren’t capable of removing humans from the process entirely, but they can take on some of the workload so that it’s less labor-intensive.

Artificial intelligence

Artificial intelligence is more advanced than RPA in that it more closely resembles the human decision-making process. Some AI algorithms use machine learning (ML) and natural language processing (NLP) to make sense of complex datasets and perform more detailed operations and end-to-end workflows.

Intelligent automation (IA)

Intelligent automation technology uses a mix of RPA and AI. It’s used for underwriting, claims validation, and more, and can be used to interpret unstructured data for manual processing or data entry. For example, an automated system with AI functionality can use optical character recognition (OCR) to digitize and categorize documents.

Types of Business Insurance Claims

Claims process automation is primarily used by healthcare and insurance companies, but commercial policyholders can also use claims processing software to file and keep track of their own business insurance claims. Here are three examples of commercial insurance claims that can be streamlined using digitization and automation.

Business insurance

Business insurance may refer to general liability insurance or commercial insurance. General liability insurance covers bodily injury and property damage to third parties, while other types of commercial insurance cover damages to your own property or premises caused by an accident, natural disaster, fraud, or theft.

In addition to filing a claim, businesses may need to perform an incident investigation to uncover the cause of the damage and prevent it from happening again. 

Workers’ compensation

Workers’ compensation insurance covers healthcare costs and lost wages associated with an employee’s work-related injury. Workers’ compensation case management can be especially complicated for HR teams, because it requires coordination between the claimant, claims adjuster, and the employee’s healthcare provider.

Claims management software like Pulpstream can simplify workers’ comp with OSHA report generation, return-to-work event tracking, and more.

Cybersecurity insurance

Cybersecurity insurance covers losses related to hacks, data breaches, ransomware, and other IT-related incidents. Using a cloud-based claims management solution can help you mitigate risks by detecting fraud and other irregularities in your insurance claims data, while complying with customer privacy and data-retention laws.

You can also use automation to undertake integrated risk management focusing on cyber risk, operational risk, and strategic/enterprise risk.

5 Use Cases for Claims Process Automation

Claims process automation: HR employee interviewing an applicant

Filing an insurance claim can be a hassle, but in many industries, it’s an inevitable part of doing business. Here are five ways claims process automation can help.

Streamlined workflows

One of the primary applications of claims automation is to use it to streamline the claims management process. From your first notice of loss (FNOL) to your payout, automation can eliminate the need for manual data entry and reduce the risk of human error.

By pre-filling your FNOL, OSHA reports, and other forms with information you already have on hand, you can save time and effort in the claims management process. Plus, you can use digital versions of these forms to cut down on physical paperwork.

Streamlining workflows doesn’t just boost efficiency. It also lowers your operating costs as claims are processed more quickly and with less human oversight.

Improved communication

Claims process automation makes for an improved customer experience by providing more ways for policyholders to submit a claim to their insurance provider and receive updates during the process. From mobile apps to customer service chatbots, claims processing solutions bring modern technology to the insurance process.

Pulpstream’s claims management solutions make it easy to administer any type of claim and facilitate communication between claimants and insurance adjusters in a cloud-based portal. Upload documents, set up automatic notifications, and collect e-signatures, improving resolution times and increasing customer satisfaction.

Data extraction

Claims processing can involve large quantities of data, especially for complex cases that require a workplace investigation. Key information may come from multiple data sources and in a variety of formats, including photos, videos, audio recordings of interviews, and handwritten statements.

AI and intelligent automation software can use natural language processing and optical character recognition (OCR) to extract useful information from unstructured data sets and present it in a way that humans can understand.

By digitizing and automating insurance document processing, you can gain insight into individual claims and speed up the claims management process. More accessible data can also help the claim handler and insurance adjuster assess the claim, validate the claim, and make a more accurate and efficient payout.

Claims analytics

Finally, digitizing and streamlining the claims administration process opens up the door to more detailed and advanced claims analytics. Pulpstream makes it easy to perform loss run reports and view custom claims analytics, helping you to detect anomalies in your data sets and prevent insurance fraud from happening on your watch.

View claims by month, type, age group, and more, and monitor insurance trends via highly intuitive dashboards. Advanced claims analytics can help with fraud detection, regulatory compliance, risk mitigation, and incident management in real-time.

Return-to-work process

Process automation can also be used in other areas of human resource management. For example, when submitting a worker’s compensation claim for a workplace injury, an employee may also be eligible for short-term disability insurance or a temporary leave of absence under the Family and Medical Leave Act (FMLA).

HR management tools like Pulpstream can help you handle the leave of absence and return-to-work process all in one place. You can use Pulpstream to navigate the ADA interactive process, provide accommodations, and track leave balances, providing a seamless experience for employees at every step of the process.

Streamline Your Claims Processing Workflow With Pulpstream

Manager using a computer

Claims process automation refers to the use of technology, such as artificial intelligence and robotic process automation, to handle insurance claims processing. The healthcare and insurance industries use claims processing solutions to improve efficiency, reduce human error, and provide a better customer experience.

Businesses that file a large number of insurance claims can also benefit from claims process automation. Better claims data allows you to run advanced claims analytics, ensuring regulatory compliance and reducing the risk of insurance fraud.

Pulpstream’s claims management solutions support all types of claims, from workers’ comp to general liability. Manage the entire claims lifecycle from one place, including claim documentation, insurer integration, and insurer adjuster communications.

Request a free demo today and see how anyone can use our no-code platform to streamline insurance claims!