Claims processing is a critical and integral part of Insurance Company’s business. Claims are made by customers ranging from health insurance, life insurance and general insurance for automobiles, property, household items, jewelry, etc. Insurance companies tie up with Third Party Administrators (TPAs) to process and settle claims. TPAs are paid by insurance companies for each transaction / claim processed.
In Insurance sector, customer satisfaction and loyalty is measured by their ability to process the claims with shortest Turnaround Time. At the same time, it is very important to ensure that claims are validated and processed thoroughly to prevent any leakages because of fraudulent claims, and deny or reject fraud claims. Speedy and accurate disposal of claims with stringent SLAs is very crucial, and failure to do so leads to customer dissatisfaction.
Arbiva can help you overcome challenges in claims processing by developing components that will bring efficiency and agility in faster settlement right from Pre-authorization stage to allowing cashless settlement or making a reimbursement settlement. Our solutions will significantly reduce the time taken to process each claim, thereby increasing your staff productivity.
With our experience in integrating claims software with third party rule engine, claims are processed accurately based on various combinations of Policy Conditions, Exclusions, Pre-existing Conditions, Sum Insured, Hospital Empanelment, Policy/Treatment Zone, Floater Amounts and other key attributes.
Major Functionalities:
Policy Enrolment
Provider Network Management
Claims Adjudication
On-line Pre Authorization
Automated Claims Adjudication (Rule Engine Integration)
Increase auto-adjudication rates and accuracy
Exponentially increase claims processing capacity with existing staff
Shorter time to implement business rule changes
Improved claims processing accuracy
Incorporate new product business rules without operational downtime
Online Pre-Authorization using Web Services
Cloud-based Health Information Network that enables seamless exchange of health information, leading to efficiency and increased reach for your business.
Reduction in erroneous claims
Savings in processing cost
IT solutions reduce transaction cost / complexity
Faster Settlement of Claims-Improves cash flow
Integrated with Document Management System (DMS):
Integration with Document Management System for storage in a secured way, easier archiving, access and reference, intelligent classification and distribution of documents.
Business Benefits:
Instant retrieval of documents
Streamline business process
Document version & Lifecycle Management
Retention of Digital Assets
Centralized data management
Effective Communication/Notification:
Provides Policy / Beneficiary information through Web Portal for Corporate employees and HR Managers; Allows corporate employees to submit online claim registrations and track the each stage of the claim.
Fax Integration
Auto SMS
Auto e-Mails
Provider Module to capture Hospital Tariff / Package data used for claims auto adjudication.
Role based Authorization implementation to display secured information to authorized users/approvers to approve the higher claim payments/process data for VIPs
Fraud claim alerts and controlling