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Our client is a leading health insurance company based out of India. One of the core operations of the company is to approve or reject insurance claims sent by hospitals or policyholders and send them approval/rejection emails along with the amount approved.
Managing and processing insurance claims approvals or rejections is a lengthy and complex process. The insurance company receives claims requests on email from TPA Cells in different empanelled hospitals. The company handles claims manually relying on the expertise and experience of the employee that processes the claims. Moreover, the claim requests from different hospitals are sent in different formats that contain patient information and claim value including the surgical and stay charges.
Upon receiving the claim request email, the employee has to extract important information from the forms, verify the information, and eligibility of claim through different steps. The manual process is not only time-consuming and a repetitive task, but it is also prone to errors leading to wrong processing of claims. As a result, the insurance company faces the risk of increased operational costs, high IT costs, and delays in claim processing. The complex claim approval process takes long hours which results in high manpower costs.
Managing and processing insurance claims approvals or rejections is a lengthy and complex process. The insurance company receives claims requests on email from TPA Cells in different empanelled hospitals. The company handles claims manually relying on the expertise and experience of the employee that processes the claims. Moreover, the claim requests from different hospitals are sent in different formats that contain patient information and claim value including the surgical and stay charges.
Upon receiving the claim request email, the employee has to extract important information from the forms, verify the information, and eligibility of claim through different steps. The manual process is not only time-consuming and a repetitive task, but it is also prone to errors leading to wrong processing of claims. As a result, the insurance company faces the risk of increased operational costs, high IT costs, and delays in claim processing. The complex claim approval process takes long hours which results in high manpower costs.
Managing and processing insurance claims approvals or rejections is a lengthy and complex process. The insurance company receives claims requests on email from TPA Cells in different empanelled hospitals. The company handles claims manually relying on the expertise and experience of the employee that processes the claims. Moreover, the claim requests from different hospitals are sent in different formats that contain patient information and claim value including the surgical and stay charges.
Upon receiving the claim request email, the employee has to extract important information from the forms, verify the information, and eligibility of claim through different steps. The manual process is not only time-consuming and a repetitive task, but it is also prone to errors leading to wrong processing of claims. As a result, the insurance company faces the risk of increased operational costs, high IT costs, and delays in claim processing. The complex claim approval process takes long hours which results in high manpower costs.
