Efficiency Improvement
International insurer makes major efficiency gains by using Avola Decision to handle claims
More efficient handling of claims as an objective
Customer focus is a top priority in every industry. Insurance companies are also increasingly realizing that consumers and business customers want quick action, flexibility and transparency. One of our customers in the insurance industry, which handles more than 100,000 claims annually, implemented Avola Decision. This improved efficiency, productivity and customer experience at this international company.
- Handle claims more efficiently
To save time on administration. - Work more customer-oriented
By freeing up more time for customers. - Find documents faster
By starting to process claims completely digitally.
Improve a complex, manual process
The biggest challenge was that claims handling was a complex, inefficient and largely manual process. Normally, claims handlers receive claims on behalf of their clients. To decide whether the customer should receive a refund and, if so, how much refund they were entitled to, each claim had to be personally evaluated by a claims handler. Because each customer had different conditions and specifications that needed to be taken into account, this is a complicated process.
Time-consuming task
To make things even more complex, the claims handling company works with Service Level Agreements (SLAs) for each customer. These agreements define and quantify how claims from these customers are handled. For example, step 3 in the claims handling process is not relevant to customer A and thus should be skipped. Customer B’s SLA states that the maximum turnaround time for a claim is 3 weeks, rather than the usual 4 weeks. It is abundantly clear that without adequate management of the rules contained in the SLAs, handling a claim is a very time-consuming task.
A second challenge was that too much time was spent tracking down the correct documents. Each claim was processed on paper, so tracking down the documents for a specific claim was not easy and led to delays in processing the claim. This led to productivity problems because claims handlers spent too much time either processing a claim or finding a claim in the archive.
Translating SLAs into business rules
To simplify and speed up the claims handling process, they chose to implement Avola Decision. This platform helps them identify the logic and rules used to make decisions. SLAs are an essential part of our client’s claims handling process and, at the same time, are the biggest obstacle to speed and efficiency.
Therefore, we recommended translating the rules from the Service Level Agreements into rules in decision models. This allows Avola Decision to allow the handling company to use the SLAs to drive the process efficiently. If the SLAs change along the way, the business rules in Avola Decision can be easily modified without the help of the IT department. In this way, flexibility is also ensured.
What is Avola Decision?
Solution: 30% more efficiency, improved transparency and customer experience
By separating the business logic from the process and using SLAs to automate the claims handling process, claims handlers benefit from several advantages. Claims handlers no longer have to go through each step of the process manually. This has resulted in increased productivity and a decrease in turnaround time. With Avola Decision, the insurance company was able to achieve a 30% efficiency improvement.
When claims require human intervention or need to be handled before a specific deadline as stated in the SLA, Avola Decision automatically routes the claim to the claims handler with the appropriate skills and prioritizes the claims that need to be handled first. Thus, Avola also ensures that claim handlers’ time and competencies are used as efficiently as possible. By integrating OCR technology, the platform can even interpret situation sketches on claim forms to help decide who is responsible for the claim.
Avola Decision allows the claims handler to put the customer first. By saving time in the claims handling process, there is more time to handle complicated cases and add a human touch. For example, if a customer has been in a car accident, there is more time to ask how the customer is doing and how they are recovering. This seems like a trivial detail, but it can be vital to the customer experience.
In addition, the platform has improved the transparency of the decision-making process. Avola Decision provides easy insight into the business rules used to reach a particular conclusion. Instead of a black box, the decision-making process is fully transparent. The platform also reveals the consequences of specific business rules. Users can easily test the impact of any changes. This allows the insurer to run different scenarios before actual changes are made to the system.
- Efficiency improvement of 30%
Through partial automation of the claims handling process. - Customer first
More time for personal contact with customers. - From black box to transparency
For uniform handling of all claims.
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