CHALLENGES

Group and Voluntary Benefits Carriers

Significant human resources are dedicated to the administration of low-margin/high-volume, short-term disability and leave claims, i.e. Absence Management Services.

Carriers face challenges:

A complex maze of federal, state, and municipal regulations, coupled with corporate paid leave policies, making absence claims servicing labor intensive

Highly disjointed claims processing, requiring information from multiple parties, including employers, employees, and physicians

Poor customer experience for the claimant (employee) due to the highly manual and disjointed processes

Claimants

Claimants (employees) expect their claims journey to be effortless. They also want to stay informed and, most importantly, quickly want to know if their claim was approved. The employee experience becomes unnecessarily complicated and sub-optimal, as the number of carrier’s touchpoints increases to gather and clarify pertinent information.

Claimants Expect:

Easy claims submission at a time and place of their choice

Short wait times for a claims decision

A single point of contact for disability and absence claims

24/7 live access to claims updates

EXL SOLUTION

While EXL’s service is focused on improving the claimant (employee) experience, we can help insurance carriers reduce operating expense (OPEX) by 40-50% in the immediate- to medium-term. EXL brings together in-house, leading employee benefits talent, and best-of-breed platforms, further augmented by automation, to deliver the highest value at the lowest risk to carriers. EXL’s flexible deal structure offers committed productivity gains, variable pricing models, and gainsharing for advanced analytics transformation.

KEY FEATURES

EXL’s Claims as a Service (CaaS) helps clients deploy new operating models that significantly reduce OPEX while improving claimant experience (CX). It addresses the key components of the operating model, i.e. people, process, technology, and metrics. Claimants Expect:


People

 
  • Drive value by sourcing all roles other than customer-facing ones, in the immediate term
  • Rebadge customer-facing and select SME roles
  • Revisit multiple roles within claims function
  • Align claim teams by book of business
  • Staff for customer service, low-complexity back office, and high-complexity claim adjudication and clinician skills
  • Deploy employment law counsels to support American with Disabilities. Act claims and compliance with new leave legislations



Processes

 

Maintain a single point of contact for the claimant for disability and absence claims – creating an end-to-end claim ownership.

Intake and Eligibility

  • Deploy self-service automation via EXL’s Intelligent Virtual Assistant to make claims intake a low touch, effortless experience
  • Intake telephonic claims through nurses
  • Institute an Artificial Intelligence (AI)-powered automation for fast/rapid claims. e.g. simple maternity
  • Automate eligibility decisions for all claims through a combination of employer file feeds and validation of claim, policy coverage, and employer special handling data

Core Case Handling

  • Automate the claims review processes to support experienced claim specialists
  • Make next-best recommendation from an analysis of various data: Intelligence:
    - Reason for leave
    - ICD 9/10 codes
    - Last working day
    - Leave duration
    - Attending physician statement
    - Employer file feed
    - Coverage information
    - Special handling instructions

Initial Decision

  • Automate fast/rapid and routine claims
  • Use data- and analytics-driven claims duration determination for most-frequent claim reasons Deploy experienced claims specialists supported by clinical staff for complex claims

Ongoing Claims Management

  • Continue the claims specialist to maintain single point of contact.
  • Leverage data to uncover claims propensity to transition from short-to long-term disability
  • Refocus efforts to proactively manage complex, improved return-to-work dates



Technology

 

EXL is technology platform agnostic, and has developed a suite of digital assets for automating the claim process. Additionally, EXL can bring partners for best-of-breed technology platforms.

  • Intelligent Virtual Billing Assistant - Natural Language Processing (NLP)/AI-driven self-service automation for claims intake
  • Intelligent Content Extraction Algorithm - NLP/ AI smart content extraction from unstructured documents to review and auto adjudicate fast/rapid and routine claims
  • Claims Duration Analytics - Data and analytics models predicting accurately claims duration
  • Return to Work Analytics - Data and analytics models to uncover claims ripe for clinical intervention for improving return-to-work dates

Key Benefits

Improved Customer Experience

  1. Customized journeys by claimants
  2. Single point of contact for claimants
  3. Shortened customer wait time
  4. Proactive outreach

Low-touch/Straight-through Processing that Leverages EXL’s Digital Assets

Maintain and Continuously Improve Key Metrics

  1. Eligibility notice sent within 24 hours
  2. Claims adjudicated within three business days
  3. Improved customer satisfaction scores

40 to 50% Reduction in Operating Expenses

 

Get in touch with our experts:

Munish Mahajan
Vice President, Group Benefits
 
 
 
 
Gaurav Singh
Director, Group Benefits Consulting
 
 
 
 

Contact US