Case Study

Revolutionizing Claims Administration Through Automated Efficiency

About the Company

Driving Operational Excellence in Claims Management

In the dynamic realm of claims administration, efficiency and accuracy are paramount. Our client faced the challenge of managing a high volume of claims and examinations annually, requiring meticulous attention to detail and swift processing capabilities.

Business Challenge

The client faced several critical challenges:

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High Volume Processing

Managing high volume of cases and examinations annually demanded streamlined and automated processes to ensure timely resolution.

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Complex Claims Triaging

Dynamic validation and verification of 100+ attributes across claims required advanced automation to expedite processing and minimize errors.

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Appointment Management

Efficient scheduling and routing of medical examinations based on specialty needs, ensuring optimal provider alignment and secure medical report transfer.

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Automation Needs

From auto-generation of Questionnaires to automated appointment extensions based on real-time data, the client sought to integrate comprehensive automation across their claims administration processes.

Solution Approach

Infinite devised a robust solution leveraging cutting-edge automation technologies:

Claims Triaging and Validation

Implemented dynamic validation algorithms to verify over 100 claim attributes, ensuring accuracy and compliance with regulatory standards.

Automated Assignment and Reassignment

Developed automated workflows for reassigning claims based on complexity levels and batch processing capabilities to optimize workload distribution.

Appointment Scheduling and Management

Integrated intelligent routing algorithms to match examinations with suitable providers based on specialty needs, with automated scheduling and rescheduling functionalities.

Communication and Collaboration

Implemented context-aware chat functionalities for seamless communication with providers, alongside notifications and alerts management to ensure timely updates and scheduling changes.

DBQs Generation and Management

Automated the generation of Disability Benefits Questionnaires (DBQs) and calendar management, triggering additional examinations based on real-time responses and needs.

Invoice, Audit, and Reporting Automation

Enabled auto-generation of invoices, integrated audit workflows, and provided access to real-time and historical data for comprehensive reporting.

Outcomes from Infinite’s Solution

The implementation yielded significant results:

Enhanced Operational Efficiency

Automated processes reduced manual intervention, resulting in faster claims processing and reduced error rates.

Improved Provider Collaboration

Context-aware communication tools facilitated seamless interactions with providers, enhancing collaboration and service delivery.

Optimized Appointment Management

Automated appointment scheduling and extension functionalities streamlined logistical operations, ensuring timely and efficient medical examinations.

Comprehensive Dashboard and Alerts

Management dashboards provided real-time insights into claims status and performance metrics, supported by proactive alerts and notifications for critical updates.

Cost Savings and Efficiency Gains

Achieved significant time savings across various processes:

Employee Engagement and Strategic Insights

Improved employee engagement by shifting focus from transactional tasks to judgment-intensive skills development. Provided analytical insights to senior leadership for strategic decision-making and best practice extraction from high-performing departments.

Driving Innovation, Delivering Excellence

Infinite continues to lead in transforming claims administration through innovative automation solutions, setting new benchmarks for operational efficiency and customer satisfaction in the insurance industry.

Partnering for Continued Success

Collaborating closely with our clients, we remain committed to driving forward-thinking solutions that empower insurance providers to excel in claims management, ensuring agility, accuracy, and superior service delivery in a competitive landscape.

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