Effective Claims administration through process and rule based automation

SymbioSys Claims Management, a unique solution designed to handle all types of Life and Health Insurance claims and related products and benefits with ease. It helps Insurers in effortless management, and business rules-driven processing of all the Claims on Single Unified Platform for different teams involved and brings exceptional risk control and reduces human dependency in the process.

SymbioSys Claims Management enables Insurers to manage complete claim operation from the Claim Intimation to Claim Pay-out. It has defined processes for all distinct and common processes & teams that are involved in the claims processing like Claim Administrations, Assessment, Requirement Management, Investigation, TPAs Management, Hospitals, Finance Approval etc.

Challenges

• Speed:
  • Time and accuracy of claim administration and settlement
  • Time to market to launch new complex benefits (claims) and hence products
• Process:
  • Inability to provide timely information to customer, groups on claim process, status etc.
  • Disparate claims systems for different product lines
  • Non-availability of feedback information for effective and improved claims
• Automation:
  • Multiple Policy Admin platforms typically implemented for each type of product
  • Multiple external parties viz. providers, banks, TPA’s etc.

Business Drivers

• Automate management of insurance claims based on Business Rules
• Up-to-date Claim status information
• Efficient Claims front-office extendable to the distributors or reinsurers
• Pro-active document management

Features

• Customer centric information for in-depth analysis
• Express Claim option for simple and small value claims, and auto Approval of claim based on Business Rules
• Assignment and Reassignment of claim using skills and load management with escalations based on SLA’s
• Stage Wise Turnaround Time(TAT) analysis

Benefits

• Increased operational efficiency due to automation of routine tasks
• Effective Insurance Claim Processing
• Reduced movement of physical documents and communication cost
• Significant Reduction in claims turnaround time (TAT)
• Enhanced customer/partner service
• Reduced Time to Market for launching new types of claims