Tag: claim handling

4 Most Common Pain Points of Insurance Claims

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February 10th, 2020

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Payers and providers are often at odds when it comes to filing insurance claims. While payers want clean claims free of errors, providers want prompt payment. These aren’t always adversarial goals, but frustrations and errors can happen if a payer or provider is hasty while processing a claim. Errors can take a while to fix which costs both parties in resources and time as they rework the claim.

Of all the challenges providers have to navigate while processing claims, the following are the most headache inducing:

  1. No or slow information from the payer. Following any service, providers code the claim and submit it to their payer. However, waiting for an update can be a long process that leaves many providers wondering when or if they’ll receive payment. As a result, many providers follow up frequently, which takes up valuable time.
  2. Claim denials. While a denial at least lets providers know where they stand in the claims process, it’s not the update they were hoping to receive. The denial process is often murky as payers aren’t always clear on the reason why they denied the claim.
  3. Vague feedback. Continuing with the above point, payers return claims unpaid for a variety of reasons, but they always include a code as to why. However, these codes can be vague and frustrating for providers such as claim/service lacks information. Without any specification as to what is missing, providers have to hunt and guess for the reason.
  4. Rules are different for every payer. Even if the services that providers offer never vary from person to person, the method of coding differs among payers. This makes it challenging to navigate the claims process as one payer may consider a submitted claim clean while another may reject that same claim. Compounding the problem, rules change often with little notice, which can muddle claims as well.

Improving communication between payers and providers can help reduce rejected claims and expedite payment for services. However, submitting clean claims the first time around is also critical to saving time and reducing hassles. Implementing a full service claims management program can help achieve that goal. Contact the experts at Actec to learn more about improving claim management.

Number One Reason Why Customers Switch Insurance Companies

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November 4th, 2019

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Customer retention is a huge part of the financial stability equation for insurance providers. It costs significantly more money to acquire new customers than it does to retain existing accounts, but many insurers struggle to identify what is important to their current clients as well as pain points that influence them to find a new insurer.

What Do Policyholders Want?

Not much has changed on the playing field regarding what policyholders want from their providers, which leaves many insurers flummoxed on what needs modifying. However, customer expectations are significantly higher than in previous years due to a massive increase in technology. Researching rates, typical settlements, and more are easier than ever. Online reviews and mobile apps also play a critical role in how individuals choose their insurance providers.

However, the single most pivotal influencing factor on a customer’s loyalty is their claims experience. This explains why 30% of customers report they’re considering changing insurance companies in the coming year despite 93% describing themselves as satisfied with their current provider. What’s even more telling is that customers who filed a claim in the preceding two years reported they are twice as likely to switch providers. What’s intriguing is the claim outcome, good or bad, doesn’t play a role in their decision.

6 Key Claim Factors That Cause Customers to Defect

Because customers with positive claims outcomes are still more likely to switch insurance providers, insurers need to know what aspects of the claims process is driving the change. While the perceived fairness of the settlement will always top customers’ lists, insurers need to focus on the following to guarantee customer satisfaction during the claims process:

  1. Speed of settlement
  2. Transparency of the claims process and explanation of the next steps
  3. Ease of communication with the insurer to receive an update at any time
  4. Regular, timely updates without the customer reaching out first
  5. Empathetic insurance representatives
  6. Multiple communication methods to discuss the claim including phone, email, mobile app, etc.

The biggest takeaway is that the final outcome of the claim isn’t always what matters to customers. Even if they receive a settlement that makes them happy, customers will start shopping for new providers is the experience of the claims process is lacking.

If your insurance company is struggling with an outmoded claims process, Actec can help. Contact us to learn more about our full-cycle claim and incident reporting solutions.

How to Solve the Top 4 Challenges in Claim Status Inquiries

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October 7th, 2019

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Monitoring the status of a claim is important to ensure it funnels through the correct channels without time-consuming errors, denials, and more. However, providers often report that monitoring a claim’s status is a heavy burden as it takes up considerable time. While one claim only requires around 14 minutes and costs an estimated $7.12, medical providers made 737 million claim status inquiries by phone, fax, or partial electronic means in 2018 alone.

The following are the biggest hurdles for providers, practices, and billing teams when it comes to claim status inquiries:

  1. Manual inquiries are costly and time consuming. Looking at the statistics above, manual claim inquiries cost billions of dollars and took up millions of work hours.
  2. Claim status inquiries don’t yield actionable results. Many claims follow their course as they should, which means providers waste their time following up on claims that aren’t at risk of denial.
  3. There are often limits to how many inquiries a provider can place on one call. This means providers must make multiple inquiries, taking up even more time.
  4. Lack of visibility makes prioritization difficult. Providers can’t intrinsically know which claims offer the highest yield, which can mean they give unnecessary time and attention to lower priority claims.

The simplest way to shorten the amount of time and money spent on claim status inquiries is to automate the process. Compared to manual and partially electronic claims, fully autonomous claim status inquiries cost $1.89 per claim and only take up around five minutes of the provider’s time. This means with 100% electronic claim status inquiries, the healthcare industry could save as much as $2.6 billion per year.

Improving the claims process from start to finish not only improves customer satisfaction, but it also helps save time and money for the provider while boosting transaction rates for the insurer. Insurance companies will receive more claims on a faster timeline, which translates to more cash flow. To learn more about improving the claims handling process, contact the experts at Actec.

Leveraging Analytics to Improve Claim Accuracy and Customer Outcomes

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April 1st, 2019

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Insurers have to go through a lot of information when working a claim. They receive notes from adjusters, details from customers, and then have to compare it all against fraud analytics. With each insurance representative handling numerous claims, there isn’t enough time in the day for them to sift through every piece of data they encounter.

With data analytics, insurance companies can better track claims escalation, priority, and potential fraud. The following are several ways data analytics can improve insurance claims:

  1. Fraud detection and prevention. Out of every ten claims that cross an insurance agent’s desk, one of them will be fraudulent. Prior to data analytics, fraud detection was limited to rules-based programming that fraudsters could easily trick. Now, insurers can use predictive analysis to apply rules, search databases, make models, and more for more accurate fraud detection.
  2. Handling litigation. Sometimes customers dispute claims and they end up in litigation. Data analytics can pinpoint factors that typically lead to litigation, which allows insurance companies to assign those claims to more senior agents. Their skillset can allow them to settle those claims faster and at a lower expense.
  3. Assigning claims. This isn’t limited to litigation. Agents have varying areas of expertise and ensuring claims are assigned to the best fit can be a challenge. Agents often receive claims based on very limited data. As a result, claims often end up being reassigned, which causes delays and irritates the customer. Data analytics can group loss characteristics to assign claims to the adjusters that fit best.
  4. Improving settlement accuracy. When claims come in at a regular pace, insurance agents can give each one more attention. Following a disaster, however, settlements often get fast-tracked to help customers sooner. However, issuing blanket checks can result in exorbitant or unfair settlements. Analytics can help balance settlements by analyzing claims against claims history.

Using data analytics can help insurance companies differentiate themselves from local competition. Data can also help improve the customer’s experience, boost retention, and save money. Contact the experts at Actec to learn more about improving your claims processes.

Increase Customer Satisfaction After Receiving a Claim

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November 5th, 2018

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First notice of loss (FNOL) represents the single greatest opportunity to establish a positive experience for customers filing insurance claims. However, while it’s the biggest, it’s not the only moment that can score customer satisfaction points. The following are several methods insurance representatives can use to improve the claims process following FNOL.

  1. Keep it simple. Many customers choose to report a loss over the phone, but there are a number of mobile options available to them. However, many of these mobile platforms lack clear instructions on what the insured needs to provide. This means a representative will have to call them and ask them to clarify everything they already provided. This causes the customer to feel harangued and irritated. By providing clear details on mobile apps and websites, insurance providers can ensure a smoother experience.
  2. Speed it up. Many claims stall during the evidence collection phase. Numerous insurers schedule and send out adjusters to assess the damage. Unfortunately, the resources needed to collect and assess the claim’s data are often lacking, causing delays. The more successful insurance providers are starting to rely more heavily on mobile apps to help them collect information to avoid these aggravation-inducing delays.
  3. Update often. Even if there is no change in a customer’s claim status, he or she wants to know about it. Leaving customers wondering where they are in the claims process is frustrating. This can be as simple as an automated email or as personal as a phone call.
  4. Rapid payouts. When an insurer settles a claim, the customer understandably wants their money as fast as possible. While many insurance companies still send check in the mail, some are beginning to offer direct deposit as a much quicker option.
  5. Follow up. Many insurance companies sever communications with customers once they close their claims. However, this wastes a valuable opportunity to get feedback from customers. Insurers can learn where the pain points are in their processes and identify ways to improve.

Considering that 20% of customers never complain and opt to find a new insurance company instead, it behooves insurers to make their claims process as easy and pleasant as possible. To learn more about improving the claims process, contact the experts at Actec.

How to Improve Claims Management Workflow in 3 Simple Steps

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June 5th, 2018

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shutterstock_251707783 smThere are only so many hours in a day, but clients don’t care about their insurer’s workflow problems. They want answers to their questions, rapid resolutions for their claims, and quick payouts for settlements. While insurance companies can’t make the day any longer, they can optimize their existing procedures to improve efficiency. The following are several ways to improve the claims management workflow.

Consolidate and Share Data

Insurers that rely solely on spreadsheets limit their service abilities. When insurance agents and adjusters need to access information about a claim, a massive excel spreadsheet is not the most efficient method. Storing data on several databases also makes it difficult to find all of the relevant information, which slows down the claims resolution process. By storing all data in one location and granting access to all relevant employees, insurers can speed up the claims management cycle.

Prepare for Emergencies

Many businesses operate well enough until they are hit with an emergency. They don’t have the ability to take on the additional work, so their day-to-day tasks sit on the sidelines until they can resolve the problem. This creates a looming disaster, as the sheer volume of backlogged work will swiftly overwhelm employees. If insurance companies consolidate their data as suggested above, adjusters and agents can access the information they need much faster, which better enables them to handle emergency situations.

Look for Trends

When data is easier to access and view, insurers can identify trends much faster. For example, an insurance company may notice certain natural disasters provoke more fraudulent claims than others do. They can then look at those false claims and search for commonalities to red flag similar claims going forward. This can save hours of time otherwise spent working on a case that may or may not be duplicitous.
Resolving bottlenecks in the claims management process doesn’t always have to be complicated. Sometimes, it’s as simple as revamping an existing system to make it work better. If your claims management process is causing headaches, contact the experts at Actec to learn how we can help.

How to Ensure Customer Satisfaction During Insurance Claims

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May 21st, 2018

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shutterstock_138016598 - CopyInsurance companies run any number of ads to try to lure new customers; however, retaining customers is just as critical for success. The best way to keep customers loyal is during the claims process. When a customer files a claim, they are often in a vulnerable state. They likely experienced a loss of some kind (i.e. car accident, theft, etc.) and need their insurance company to help them through the process. If their experience is less than satisfactory, customers may begin looking for a new insurer.

First Notice of Loss

First notice of loss (FNOL) is one of the greatest opportunities for insurers to guarantee customer satisfaction. This period of time is when the client is most upset as they are filing a claim right after an accident or loss. Insurers can improve their customers’ satisfaction during this phase by minimizing the amount of effort the client has to put forth. However, while FNOL plays a pivotal role in customer satisfaction, it presents less of an opportunity to improve the overall claim experience.

Acting in the Client’s Best Interest

While many insurers know that FNOL is vital to customer satisfaction, not as many realize that customers place a higher premium on their insurance company acting in their best interest. This part of the claims process can improve customer satisfaction and the overall claims experience. Factors affecting this include:

  • Managing the client’s expectations
  • Minimizing or eliminating surprises by supplying the client with solid information
  • Resolving the client’s issues the first time

Dialing in the Claim

Insurance adjuster can use a few additional approaches to improve the claims process. While they do not do much to improve the customer’s overall satisfaction, they do affect customer retention. These include:

  • Knowing the client’s personal information
  • Providing a personalized experience
  • Finding the client’s preferred contractor for repairs

Insurance companies that focus on the above can improve their customers’ satisfaction as well as their overall claims process. These two factors are vital to improving customer retention. If you’re losing customers to the competition, it may be time to overhaul your claims process. Contact the experts at Actec to learn how we can help.

New California State Claim Reporting Requirements Beginning January 1, 2017

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January 16th, 2017

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shutterstock_250505056 - CopyThe State of California recently amended the California Workers’ Compensation Uniform Statistical Reporting Plan. As of January 1, 2017 it now requires insured employers to report first aid claims to their claims administrators. This does not apply to self-insured organizations that handle claims in-house.
Common types of workers’ compensation claims include:

  • First Aid Claims, described by the California Labor Code as those involving a single treatment and subsequent observation of a minor injury. This might include antiseptics, bandaging and non-prescription medication.
  • Incident Only Claims are actually not claims at all, but rather documentation of an incident that does not result in any treatment or disability.
  • Indemnity Claims involve exposure to indemnity benefits (temporary or permanent disability).
  • Medical Only Claims involve treatment which exceeds the definition of first aid but does not involve any indemnity exposure. A medical only claim can cover a maximum of 3 days of lost time.

Common practice has been for employers to handle first aid in-house, without documentation. This can save time and have a positive effect on experience mods (and therefore insurance premiums). This change in policy suggests that the State of California now considers these hazards relevant to the overall safety conditions of a workplace. To learn more about how these changes could affect your organization, contact us.
 

FNOL Strategies: Top 5 FNOL Blog Posts

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December 21st, 2015

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First Notice of Loss (FNOL) call centers are more than just a method for your customers to file a claim. They are a way to differentiate your company from your competitors and improve customer satisfaction.  Whether you handle FNOL reporting in-house or outsource your call center process to a third party, it is important to understand FNOL strategies.
Our five most popular blog posts will help you comprehend vital aspects of FNOL, including:

  • The significance of workflow managementabsence management video image border
  • The software, hardware and human resources necessary for FNOL management
  • How to balance business needs with state requirements and customer demands with FNOL reporting
  • How a multi-channel FNOL strategy is important for customer satisfaction
  • The value of creating a one-call solution for FNOL reporting

The top five FNOL blog posts of 2015 are:

Reducing costs while increasing customer satisfaction will improve the ROI of FNOL management. Third party call centers are an effective alternative for in-house FNOL reporting. Third party companies have the up to date solutions and trained staff to handle a variety of FNOL reporting services and can offer professional solutions for reasonable rates.
To help your company understand the intricacies of customer intake solutions, claims handling and first notice of loss, contact the experts at Actec today.

Improve FNOL One Call Intake Management

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December 7th, 2015

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shutterstock_138016598 - CopyCreating a one-call solution for FNOL management improves customer satisfaction and claim processing. Having the right staff, software and process in place will help get the right data in the right place in the shortest amount of time.
Incident Reporting in One Call
FNOL call centers are meant to help customers report an incident in a single call. In order for this to happen, you need:

  • Adequate staff for 24/7 365 reporting
  • Trained staff that can collect all relevant details
  • Software that files data electronically
  • Processes that reduce paperwork and unnecessary communication

Call center operators need to be able to enter all information quickly and efficiently so that they can reassure your customers and advise them of necessary next steps. This isn’t always possible in-house, so some companies look to outsourcing.
Outsource Requirements
When reviewing possible FNOL call centers you should make sure that, they meet basic requirements, including:

  • Adequate staffing of trained operators
  • Up to date systems
  • Personalizes solutions to meet your needs
  • Ability to escalate the call when necessary

These requirements will help your customers receive the customer service solutions they deserve and your company receives the data it needs to complete the loss management process.
To help your company understand the intricacies of customer intake solutions, claims handling and first notice of loss, contact the experts at Actec today.