Case Study

Claims Processing – Improved Client Services, Increased Document Process Efficiency, and Reduced Compliance Risks

Business Challenges

Our client, a leading global financial services company, provides innovative membership services, loyalty programs, direct-marketed insurance benefits, identity and data breach protection, and value added checking programs.

Customer claims related document management processes were manually intensive, inefficient and costly. The paper claims documents received at the mailing centers were being scanned and indexed by an outsourced vendor and stored on shared drives, creating inefficient hand-offs, costly processes, and potential compliance risks.

The client sought to improve customer service, mitigate compliance risks, improve efficiencies and reduce costs through the implementation of an on-line Claims Processing service, together with a framework of automated process and workflows for the capture and management of all documentation related to claims. The on-line Claims application and Document Management solution was required to interface to the existing Claims Processing application.

The ArborSys Solution

Our team developed the detailed requirements and design, and collaboratively implemented the on-line Claims services, and Document Management solution for the management of all claims documentation. Paper documents received from customers were scanned/indexed and inducted into the repository. Documents uploaded via the on-line Claims application were imported via Web Services into the repository. Workflows were implemented with appropriate forms and Task queues to process the Key from Image, QA, QC, and Error Corrections processes.

Supervisors could monitor workflow queues, perform workload balancing, and reassign tasks. Workload and performance metrics reports were implemented via the integration of a Reports Server:

Insurance Claims Workflow

Our solution leveraged the EMC Documentum Claims Processing framework, and extended the framework to implement pre-configured forms and workflows for Claims transactions. Our solution integrated to the on-line Claims application via Web Services for customers to upload or view submitted documents, and uses file export of transactional information for upload into the primary Claims Processing application.

Value Delivered

Key benefits delivered included:

  • Improved efficiencies and time-to-market;​​
  • A reusable repository and transactional framework for all client claims documentation;
  • A single repository for Claims related documentation, with consistent records policy enforcement;
  • Reduced compliance risks and costs.​​​