Inside the Briefcase

How to align your visual brand guidelines and create consistently on-brand content

How to align your visual brand guidelines and create consistently on-brand content

In this ebook, we’ll explore the various themes leading...

Your B2B Content Strategy in 2017: How To Think Like A Movie Studio + 6 Other Tactics

Your B2B Content Strategy in 2017: How To Think Like A Movie Studio + 6 Other Tactics

Jon Lombardo, Creative Lead, LinkedIn, reveals in this presentation...

2017 State of Technology Training

2017 State of Technology Training

Pluralsight recently completed an in-depth survey of 300 enterprises...

IT Briefcase Exclusive Interview: Keeping Your (Manufacturing) Head in the Clouds

IT Briefcase Exclusive Interview: Keeping Your (Manufacturing) Head in the Clouds

with Srivats Ramaswami, 42Q
In this interview, Srivats Ramaswami,...

IT Briefcase Exclusive Interview: New Solutions Keeping Enterprise Business Ahead of the Game

IT Briefcase Exclusive Interview: New Solutions Keeping Enterprise Business Ahead of the Game

with Sander Barens, Expereo
In this interview, Sander Barens...

The State of Play in Automating Insurance Claims

February 23, 2011 No Comments

SOURCE:  James Taylor

Talking about claims and using Decision Management to improve claims I recently caught up with Donald Light of Celent. Donald recently wrote a new report for Celent – Claims Systems Vendors, North American P/C Insurance 2011. This is the most recent update of the Celent study that evaluates vendors in the claims processing space. The report ranks core systems (in this case claims systems for P&C insurance) on 4 different dimensions and does so every 2 years.

Obviously these core claims processing and adjudication systems have various levels of workflow and rules built in (as well as standard features like support for reserving, claims adjuster desktops). According to Donald there is a definite trend for these core systems to now come with some kind of rules-based capability. Some of them are reasonably robust and sophisticated (though not on the level of a dedicated BRMS), others much less so. Most of this rules capability is focused on claims validation and routing but there is a growing interest by insurers on automating certain decisions and workflows, but not the entire end-to-end process. True straight through processing (STP) or auto-adjudication is focused currently on simpler claims (like windshields in auto for instance) and slowly moving up the complexity curve.

In my view, for now it seems that organizations wanting to auto-adjudicate a lot of claims will need to be thinking in terms of adding their own decisioning capabilities to these core systems – combining business rules with analytics (to detect fraud and abuse) to get high rates of auto adjudication without creating the opportunity for fraud.

Read More

Featured Blogs

Leave a Reply

(required)

(required)


ADVERTISEMENT

IBC 2017

ITBriefcase Comparison Report