CASE STUDY

Claims Predictive Analysis Delivers Reduction in Frauds and Enhanced Customer Satisfaction for an Insurance Company

Sep 22, 2016

Business Challenge: 

Improving claims management process

A US based insurance provider wanted to improve the management of its claims resolution process in order to improve customer experience while reducing management costs and insurance claim frauds.

Situation

Non-cohesive claims management data obstructing claims management visibility and process

The client’s insurance claim data was stored across various silos in its legacy claims management system, which did not provide enterprise level visibility into the process. The result was high claims processing time causing customer dissatisfaction, as well as inefficient validation to reduce frauds and risks. Client needed a system which could deliver better claims management and resolution.

Solution/Approach: 

Claims predictive analysis, risks analysis and process optimization

We used claims predictive analysis and risk analytics on the client’s historical and real time data, to identify claim patterns, create KPIs to determine the validity of claims, anticipate potential suspicious claims and fraud risks. We also utilized process optimization to generate ideas for reducing the claims processing time and costs.

Impact: 

Improved customer satisfaction through reduced processing time

Our solutions helped the client improve claims accuracy and eliminate potential frauds. The client was also able to significantly reduce the turnaround time for claims processing and enhanced its service levels, which delivered improved customer satisfaction and cost savings.

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