Claims Management

Claims Management

Making a claim can be a trying time for anyone having to participate in a manual process The forms, while often available for print from a web portal, require manual population and submission. This process leads to a multitude of service problems, inconvenient demands on the claimant and unnecessary error prone processing for the enterprise.

Interfiles Claims Management Technology (ICMT) provides enterprise and insurance claims management technology in a seamless self-service and over-the-counter client service context. Offering minimized supporting case workflows, third party data verification interfaces, and outbound financial settlement with integration across the major banks.

ICMT offers service benefit to the enterprise which addresses multiple key areas:

Eliminate manual capture of client data
Interacting with customer data by manually capturing hand written forms into a system of record is enormously damaging to data integrity across all product silos. It creates challenges in terms of data verification and accuracy, which in turn opens the institution to opportunities for identity fraud and moreover collusion from within the data processing environment. It has very damaging effects on information intelligence as poor input into digitized systems inevitably results in poor output.

Interfile claims management provides strong validation routines and electronic submission of claims data direct to your underwriting systems. It eliminates the “double capture verify” paradigm whilst providing ethical screens between origination, processing and fulfillment.


Create a single enterprise taxonomy
Building a service focused solution engineered specifically for a “single view” across the citizen landscape requires that data is normalized to the extent that all systems subscribe to either a set or subset of the enterprise data and content taxonomy. In simple terms structured identity and demographic formats need to be uniformly applied regardless of the process the citizen is interacting with. This approach sets the foundation for customer service conveniences such as only having to offer personal information once and the system populating that information into the necessary systems that require it. It further offers user benefits such as pre-population of forms and automated linkages between all supporting documentation within a case workflow.

Create automated third party data verification
In order to complete any claim process, it has to contain valid and verified data so that the assessor is making an informed decision on bona fide case data. Manually verifying claimant, medical and legal data slows service delivery dramatically and requires expensive manual intervention to progress a case. It suffers the same pitfalls as all manual processes in that it is susceptible to fraud and threatens the information intelligence platform. Interfile claims management offers third party interface connectivity to digitally verify third party information without the use of supporting documentation or placing the burden onto the claimant.

Elegantly process supporting documents
Enterprise places much reliance on supporting documents within the claims process. Like all “paper to digital” workflows, this approach is expensive due to the necessity for bulk scanning technology and large paper archives. It creates fraud opportunities and typically a very onerous verification process and unnecessary time lags for search and retrieval of specific evidence during the assessment process. Whilst it would be foolish to ignore the necessity for some supporting document processes, a modernised approach to this, which includes meta-tagging and searchable document sets, introduces a streamlined and far more effective management of the volume of documentation associated to claim and case data.

Prevent and limit unstructured engagements
This is one of the greatest efficiency gains within any department. In any volume based processing environment, allowing stakeholders to interact in an informal manner outside of the audited process creates bottlenecks and normally very dissatisfied customers. Put simply every single status query, request for information or assistance enquiry needs to be placed in a formal process. Whether the citizen interacts via email, on the portal, via the call centre or through snail mail, when the requirement of the interaction is well communicated, structured and reported upon, the digital processing is greatly enhanced, the claimant understands exactly the status of their enquiry and internal case workers have immediate sight of the interaction.

Automated, audited reviewed and assessment workflows
Typically claims workflows require interaction with numerous core systems. Most commonly these include:

  • Client relationship management
  • Content management (manual and electronic)
  • ERP
  • Claims management

In non-modernised environments there are few or no automated mechanisms to access this data from a single entry point. Caseworkers are forced to interact with these systems in isolation and collate their progress status and work items manually. This creates enormous and unnecessary service delays, processing errors and disparate information intelligence. Claimants become frustrated with their poor visibility of the process and its progress and management are unable to accurately identify service issues and bottlenecks. In most instances this is more severe in that management cannot obtain timeous data as to global operational performance and efficiency of throughput.

Create quality client feedback and status updates
Interfile claims management offers status points at every point in an approval workflow, these are made available to all subsystems to communicate back to the customer.

Without a unified view of case status it is very difficult to provide clients with process and progress updates. Not having accurate demographic detail and client contact preferences and information further compounds the challenges of updating stakeholders. Typically this leads to “silo” initiatives within the fund to update clients and these initiatives whilst have admirable intention, introduce confusion as the entire process is disjointed and does not reflect a uniform client interaction framework which all subsystems can utilise throughout the case life cycle.

Provide consistent independent customer touch points
Data that reflects to internal caseworkers and personnel should be identical to data available to clients. The disconnect between information available to external stakeholders and the genuine position is almost always out of sync. Providing a uniform platform that is integrated both internally and externally immediately lays the foundation for a “Single View.” It highlights the fact that case data is dynamic and that this type of integration requires interfaces that support that dynamism.

Quality metric tracking and analysis
Disparate disconnected systems and manual processes reporting and managing operational efficiencies involves the manual collection of data and manual formulation for management and executive reporting. This process is time consuming, labour intensive and in general, not very accurate. The environment provides automated business activity monitoring and report generation, including service level escalations and automated intervention.