A P&C INSURER REALIZES A 250% ROI USING MedConnection℠ TO TRANSFORM CLAIMS

EXL’s client, a leading property & casualty insurer offering commercial and personal products, struggled with claims processing turnaround times and settlement decision accuracy. Improvements had to be made to its medical record and bill analysis capabilities for the auto and general liability lines of business. Additionally, the company needed help with creating detailed summary reports with direct access to source documents, as well as implementing an electronic, secure method to exchange medical files and outputs.

Context

Understanding how timely and accurate claims decisions can significantly improve a carrier’s market standing, EXL set out to help the insurer improve its bottom line. Doing so would take transforming the process for handling third-party bodily injury claims. These claims posed unique challenges due to their complexity, high financial exposure, and lengthy source documentation.

Leveraging its deep domain expertise, EXL began transforming the process through deploying disciplined approaches, tools, and techniques to leverage the information provided with each of these claims.

Orchestration

After careful examination of the carrier’s situation, EXL deployed MedConnectionSM, a proprietary medical record and BPaaS solution. This platform structured and analyzed a claim’s most important factors and value drivers. EXL’s medical professionals highlighted red flags for each claim, summarizing their findings into succinct, actionable reports for adjusters. These improvements were multiplied by using analytics to apply modeling and other enhancements across the claims population at large.

A rapid, easy implementation with no upfront capital expenditure required by the carrier led to several benefits including:

  • Document management and classification: EXL receives, sorts and applies standard naming conventions to incoming files
  • Data conversion: Transforms images to machine readable text
  • Document analysis: Identifies all relevant data, highlights and tags red flag content to a database following agreed upon business rules
  • Synthesis: Generates exception reports using defined templates
  • Reporting: Provides completed summaries through the MedConnectionSM portal

Outcomes

The carrier saw benefits in both its revenue and productivity. Medical reviews were performed 50% faster, and with a significant increase in accuracy. A $625 net indemnity impact was delivered per claim. Most importantly, the insurer realized a 250% return on its investment.

  • 50% Faster medical reviews
  • 250% ROI received

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