OVERCOMING OBSTACLES AND STREAMLINING THE CLAIMS PROCESS WITH MedConnectionSM

The client was a leading property and casualty insurer offering commercial and personal products, who faced indemnity and expense challenges.

Challenges

  • ~75% of records and bills were highly unstructured, and ~25% were often illegible and filled with jargon. One-third of medical pages were frequently not read.
  • Unpredictable arrival and the complexity of incoming third-party bodily injury claims caused issues
  • Claim adjusters had limited formal medical training
  • Rarely employed KPIs to monitor and manage medical analysis

Context

The impacts of the issues mentioned above included:

  • Medical record reviews accounted for taking up to half of claim handler time
  • High cost of operations
  • Increased claim cycle time
  • Lower processing accuracy

Orchestration

EXL deployed MedConnectionSM, the company’s proprietary medical record and bill BPaaS solution. This cloud platform was used to structure and analyze a claim’s critical mitigating factors and value drivers. Our medical professionals highlighted red flags and translated their findings into succinct, actionable reports for adjusters. These critical findings positioned the carrier to multiply the impact across a larger claim population by applying modeling and analytics.

SPECIFIC WORK INCLUDED:

  • Enabling technologies for document management and optical character recognition (OCR)
  • Taking a lean operations approach for activity level control and measurement
  • Skilled clinical expertise drove results by highlighting relevant data elements
  • Accurate and consistent medical record and bill analysis to support decisions

Outcomes

The challenges the adjusters faced were mitigated by EXL’s proprietary medical record and billing solution.

  • ~65-70% Improvement in efficiency
  • ~80% Time savings per claim for medical record related activity
  • ~20% Reduction in cycle time

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