The State of Claims Processing

Claims Automation is Inevitable, But Full of Opportunity

Everyone benefits from advances in claims automation technology. Customers, Processing Operations, Client Satisfaction, Product Strategy and Sales. When claims automation is approached in an intelligent and thoughtful way, everyone is happy.

In its simplest form, claims automation involves introducing technology to reduce the manual effort and time necessary to process a claim. In a broader sense, claims automation presents an opportunity to transform not only the way claims are processed, but to reset your organization’s technology-based relationship with its customers. Something that is critical to customer happiness, and business success.

Even at a base level, claims automation provides measurable benefits. But when fully utilized alongside a thoughtful strategy the immediate and long term impact can be significant.

Benefits of Claims Automation

Claims automation can deliver benefits to every facet of an organization. From micro-level task improvements to long range, macro-level business evolution and change.

Figure 1: Claims Automation Benefit Classification introduces four intersections of benefit type and benefit recipient that Claims Processors should consider when choosing how to automate its processes.

How to Realize the Benefits of Claims Automation

We know that claims automation can yield a multitude and variety of benefits. It follows that an understanding of how to design our projects to best position them to capture these benefits is critical.

Figure 2: Unlocking Benefits: How to Think builds upon the four benefit/recipient intersections by identifying key elements or concepts to guide project goals and scope.

The good news is that we have collected insights and data from each participant in the claims process that we can combine with an understanding of our technology landscape today, and into the future. Research from LexisNexis 2019 Future of Claims Study and EY Claims in a Digital Era surveyed customers, insurers, and claims processors to understand specific characteristics that lead to successful claims automation, as well as to identify what can quickly crater a program’s impact.

Claims Automation is Inevitable, But Full of Opportunity

Claims automation, at its core, is technology enabled and technology dependent. In most cases, selecting the right foundational technology and implementing it thoughtfully, yet aggressively, is the first step. Done correctly, it will enable you to meet today’s challenges while readying you for tomorrow.

The specific actions to be chosen depend on where your existing business, process, and technologies overlap. You understand the challenges your business faces today and you don’t need to have a mature answer for every scenario.

Key Takeaways

  • Automating claims can provide meaningful benefits to your customers and across your business
  • Understanding how to unlock each category of benefits will help you design the best approach to claims automation
  • Selecting a technology that meets the immediate needs of your business, and drives future business growth, is essential to remaining competitive


EY “Claims in a Digital Era, Data, analytics and AI transform the customer experience
LexisNexis “2019 Future of Claims Study, Balancing Claims Automation and Empathy, February 2019

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