One of the goals of most claims processing/member service departments for Auto, Health or any type of insurance is how to improve the efficiency of the claim document access and processing for a better customer experience, satisfaction and retention. In regards to documents, more and more insurance clients are looking to make claim document access and processing more efficient. This post will describe some of the different TSG insurance client’s experience and how additions to the OpenContent Management Suite has improved their efficiency in processing Claim Documents.
Claim Document Access and Processing – What are the Issues?
In an increasing competitive insurance landscape, efficient access to documents can be the difference between retaining a customer and losing a customer (and potentially acquaintances of the customer) forever. Pressures include:
- Customer Service – customer calls with a question and the customer service representative is pressured to quickly find the right document to answer the question.
- Self Service – policy holder/member chooses to access documents themselves and evaluates the quality of the service based on the efficiency of their access.
- Reduce average handling time – policy holders and members expect that their claims will be resolved and paid quickly
- Flexible and efficient workforce – during storm/peak seasons, customer service and claim adjuster headcount needs to be temporarily increased with minimal training and seamless onboarding for temp resources
- Long-tail claims (volume of documents) – claims with many hundreds of medical documents stretching months or years
Below are some of the different ways clients have looked to add efficiency to their claims document processing. These efficiencies include:
- Correspondence from the Claims Folder
- Claim Document Search, View and Filter
- Heads Up and Bulk Indexing
- Document Composition
- Document Creation
- Document Annotation and Redactions
- Document Viewing, Annotations and Bookmarks
- Long Tail Claim (Large Folders) Capabilities
- Bulk Actions on Documents
- Side by Side Viewing
- Automated Ingestion from Email and Fax
- Integration into Insurance Operating System
- Large File Ingestion
While we are focused on claims for this post, many of the below enhancements are relevant for case management in general.
Correspondence from the Claims Folder
One of our early insurance clients back in 2004 is a business insurer. In meeting with a lead Claims Adjuster, one of the best enhancements to their solution was the addition of outbound email directly in the Claims folder.
- Old Way – Adjuster was using outlook and was required to manually download the documents to be emailed. The Adjuster would attach these documents in an Outlook email and send. The adjuster would then go into their Sent Email and drag and drop the email (with attachments) back into the claim folder to record the correspondence.
- New Way – Adjuster can select documents in the claim folder, click send email and send the email directly from the claim folder. Audit activity of the sent email automatically capture in the system and the documents would be linked to the email without being duplicated again in the claim folder. An address book for the claim folder was maintained recording any outbound email for seamless understanding by anybody that comes into the claim folder to continue the conversation.
This feature has been enhanced over the years to include Citrix ShareFile integration, Docusign, Gmail, Box and others. TSG has a roadmap to include SmartComm, GhostDRAFT and other multi-channel distribution tools.
Claim Document View, Search and Filtering
Multiple insurance clients have improved how documents are stored and accessed within the claim folder.
- Old Way – Folders – Service representatives typically would have a glorified file system where they would create folders and subfolders for specific types of content (Legal, Contract, Communication, etc) and place the file within the folder often naming the document something to indicate the type of folder. Finding new documents required navigating through folders and looking at the names of the documents and hoping that everybody used similar patterns for naming of documents. Thumbnails and preview were not available and selecting a document required launching the document (and supporting desktop application).
- New Way – Search – Adjusters are not allowed to create folders. Instead of creating folders, folder tags are created as part of the indexing process. Adjusters can still navigate folders but most (especially large health and workers comp claims) rely on quick viewing of all documents and the ability to quickly search, filter and preview content.
This feature has also been enhanced and tuned over time for each client given specialty and type of claim. Thumbnails were also added for quickly identifying image and video content without having to view every document to find what an adjuster is looking for.
Heads Up and Bulk Indexing
In addition to being able to retrieve documents quicker, users are always looking for easier and more efficient ways to add content and documents to the claim.
- Old way – Documents are added to the system one at a time. Too often adding attributes would mean guessing the content and retyping claim content from one document to another. Accuracy is an issue as content typically isn’t viewable until it is in the new system.
- New way – Documents are added to a claim in bulk from automated processes or by the user themselves. Documents are show during the indexing processing with “Heads Up” Indexing. Document are indexed or re-indexed while looking at the document and even copying text from the document itself.
New tools coming available to leverage machine learning. Check out our Capture 2.0 roadmap.
Multiple clients have taken advantage of the ability to combine documents to create new documents within the system rather than with external tools.
- Old Way – Documents would be downloaded to the desktop and a combination of Word, Acrobat and other tools would be used to manually create a new document.
- New Way – OCMS’s “Combine Documents” capability allowed users to select multiple documents, choose pages within those documents, reorder those pages and create one high-end piece with a table of contents either back in the claim folder.
This feature was estimated by one client to reduce a typical 20 minute task to 1 minute.
to 1 minute.
For many of our clients, one of the most time consuming parts of a claim is generating letters to send to various parties in the claim. There can be hundreds to thousands of different templates and forms to choose from.
- Old Way – Adjusters would compose a document from scratch or from previous cases. This time consuming process turned adjusters into detectives to find the example letters or hunt around state webpages to try and find the forms they needed.
- New Way – Templates are stored in the repository and placeholders within the document allow for efficient generation of letters with relevant information from the claim management system. Letter generation is automated in a “TurboTax” type way that allows a few questions to be answered, and the form drives to collect the relevant information and fills out the correct form.
This not only saves time, but helps keep the process consistent to prevent mistakes or re-work if the wrong forms or templates were used.
Document Annotations and Redactions
Multiple clients have taken advantage of OpenAnnotate’s capabilities to quickly preview and annotate/redact directly from the viewer.
- Old Way – Adjuster would download document to desktop and leverage Acrobat or other tools to redact/annotate the document. Document would be required to be uploaded back to the claim folder.
- New Way – Adjuster can preview and annotate or redact directly within the browser without any download. Annotations are stored with the system as a separate layer with security. Redactions are typically stored as a new version or a new document depending on the scenario.
One client estimated this capability turned a 10 minute task to less than one minute. The viewer of documents also sees the annotations as a part of their normal view, which also saves time and mistakes by ensuring that everybody viewing the document sees the annotations rather than having to remember to launch a separate interface or check if the document is annotated prior to making decisions about the claim.
Document Viewing, Annotations and Bookmarks
For large documents (10 – 1000 pages), clients struggle with finding specific part of a document when viewing.
- Old Way – Download the entire document and the Adjuster would have to scroll through the pages to find specific sections.
- New Way – OpenAnnotate quickly loads the first page while loading subsequent pages in the background. Annotations that were made to point to sections or pages of interest to allow Adjusters, Legal or others to quickly navigate through the large documents.
Key to user performance has been monitoring the time to view documents. See this post to see how OpenAnnotate keeps track of viewing time to quickly identify bottlenecks. Regardless of the document size or length, document views are consistently fast, with one of our large volume clients averaging .5 seconds per document view.
Long Tail Claim (Large Claim Folders) Capabilities
For healthcare and workers compensation claims, there can be a large number of documents (think thousands) spanning multiple years.
- Old Way – Slow system – only could get 100 at a time, no way to search efficiently within the entire claim’s set of documents.
- New Way – Filtering and searching is allowed across the entire claim to allow for narrowing down to efficiently find the particular document that is being requested. By capturing multiple pieces of metadata during document ingestion these filters can narrow down even more by combining them together.
Bulk Actions on Documents
Repetition is a surefire way to decrease satisfaction with a system. Allowing users to perform actions on more than one or all of the documents in a claim allows for efficient behaviour inside of the claim.
- Old Way – Often times when a claim is pending potential legal action, adjusters need to quickly collect large numbers of documents for export to external parties or external council. Typically, this involves redaction of some or all of the documents to be exported to remove sensitive information about one or more participants in the claim. This would involve manually downloading each individual document, opening up each one to manually redact content in each document, and then zipping or combining the PDFs into one package.
- New Way – OCMS allows for bulk actions across checked documents on the interface, or across the entire claim. In the above scenario, clients can bulk redact an entire claim by choosing what terms that need to be redacted and applying these redactions to the entire claim. This redacted package is then combined into one pdf for quick export.
In one client scenario, this bulk document action was estimated to save over an hour of time by combining these activities in bulk actions.
Side by Side Viewing
The goal of efficiencies for a claim document system are to quickly get the adjusters what they need so that that they can read the documents and make decisions based on their content.
- Old Way – In old interfaces, typically adjusters would be forced to view documents one at a time. If the document was an email or a MS Word doc, the native application (Outlook or Word) would need to be re-launched for each document to be viewed (slow). Users can quickly be overwhelmed by all of the applications being opened when hunting for the document that they are trying to find.
- New Way – Rendition everything to PDF and view the document in the browser using OpenAnnotate. By allowing documents to be viewed natively in the browser, documents can be viewed in less than a second, and users don’t loose their place in the document list by viewing the document list and the document content in a side by side viewer. Once the user finds the particular documents they are looking for, they can choose to launch these documents in separate tabs, or choose two documents to view side by side for comparison.
One client’s feedback was that this feature alone saved minutes per call as it allowed them to very quickly respond to questions from the caller. Service representatives typically do not have the context to know what this specific claim contains, so by quickly allowing the representative to navigate the claim they are able to quickly become knowledgeable with the claim to quickly answer a caller’s question.
Automated Ingestion from Email and Fax
Document ingestion is one place that we have seen automation be successful at our clients.
- Old Way – Adjusters would manually take the email from their Outlook inbox to import into the claim. They also may be required to enter in some attributes about the document to get it filed correctly.
- New Way – Automated ingestion from inbox. We have seen many clients set up a ‘firstname.lastname@example.org’ email address available to send correspondence and attachments emails to that allow for automatic ingestion. If Claim Number is in the subject line of the email then automatically put in claim and alert claim system that a new correspondence has arrived. If a claim number is not able to be determined, the OCMS Indexer can be used to efficiently file documents to the correct claim.
Integration into Insurance Operating System
Clients often struggle with document and data management of systems. Insurance operating systems (ex Guidewire), will typically do a great job managing the data and claims process (ex policy number, claim number, participants…).
- Old Way – Adjusters would be working in a “swivel chair” mode, with their Claims system on one screen and their claims document system on another screen. Depending on what the adjuster is doing, they may have to type in the claim number into multiple systems in order to look up the information or documents they are looking for.
- New Way – Tight integration of Claims System with the Claims Document system. Typically an adjuster starts working in their claims system like Guidewire. When the policy holder/member call comes in, they pull up the claim information in that system to get the basic information about the claim. If the caller asks a question that requires the adjuster to view a document, there is an integration for them to click and quickly launch an individual document, or view all documents for that claim.
This type of integration simplifies the document management implementation as the document security is maintained by the insurance operating system allowing the claims document system to focus on performance and efficiency.
Large File Ingestion
At our Auto, Property, and Workers Compensation clients they have started to see an explosion of audio, video, and photo media being produced by their policy holders. Dashcams, security cameras, and camera enabled phones everywhere are capturing more and more footage that can make or break the outcome of a claim. As consumer devices have taken off, getting and storing this data has been a struggle for some of our clients.
- Old Way – In old systems, there is no way to get video or large image files into the claim folder. These files are too big to email, and policy holders didn’t have a way to get these large files into their adjuster short of mailing in a thumb drive or CD with their video footage.
- New Way – Leveraging the cloud, many of our insurance clients are now leveraging S3 on AWS or Block Blobs on Azure as efficient way to allow large files to be uploaded. Once the files are uploaded into AWS or Azure, the files can be quickly viewed/annotated using OpenAnnotate Video right in the case folder with all of the rest of the claim documents.
Adding efficiency to Claim’s Document processing (or any case management solution) involves looking at what activities users do and how to make them quicker and easier. Ease of use and performance are tied to activities users do often. Next Generation solution combine high performance interfaces with an understanding of common activities and struggles claim users experience on a daily basis.