As a small or medium-sized business, you aren’t in the insurance industry — and yet you may find yourself dealing with insurance claims from time to time. Whether it’s a workers’ compensation or business liability claim, having an efficient claims intake process reduces processing times and leads to faster claim resolutions.
But what goes into insurance claims processing, and is there a way to gather claims information accurately without relying on time-consuming manual processes?
Here’s what business owners need to know about claims management and how you can use workflow automation to streamline the claims intake process.
The claims intake process is the first step in the insurance claim lifecycle. It involves filing an insurance claim and gathering the information needed to support it, such as photographic evidence, witness statements, and other supporting documents.
The claims intake process can be done over the phone, through a website or mobile app, or via another method provided by your insurance company. Business owners can take charge of the claims handling process with a claims management system that streamlines communication with insurance companies and other stakeholders.
You can use your claims management solution to automate:
Claims automation provides a better user experience for employees involved in the claims intake process and speeds up claims resolutions for policyholders.
What does it mean to automate the claims intake process? Just as with other types of business process automation (BPA), claims automation involves digitizing paperwork and using software to perform repetitive tasks that don’t require human input.
Here are three key features of claims automation tools.
Intelligent document processing (IDP) takes care of the tedious work involved in data entry and form-filling. IDP tools can use optical character recognition (OCR) to “read” scanned documents and turn them into usable data sets. They can even standardize information across multiple document types (PDFs, spreadsheets, Word documents, and more), helping you store data securely and reduce data silos.
Pulpstream’s document automation tools integrate with other tools that you’re already using and even support the collection of e-signatures on key claims documents.
Some claims processing tools use artificial intelligence to help you make sense of claims data. Machine learning tools use algorithms to sort structured and unstructured data sets faster than humans can by hand. With intelligent automation, claims professionals can process data quickly and improve operational efficiency.
Plus, you can use data analytics tools to view your claims analytics and identify trends related to your business insurance claims.
Some parts of the claims intake process may require human input and decision-making. Claims automation tools can still play a role by notifying stakeholders in real time and letting them know when they need to take action or provide additional information.
Pulpstream’s claims administration tools offer email and SMS notifications, helping you coordinate action between employees, insurance adjusters, and other stakeholders.
The claims intake process is just the first component of claims management, but it’s an important step. Depending on the type of claim, the claimant may file it directly, or you may file it on their behalf (as in the case of filing a workers’ compensation claim).
Here are the key steps involved in the claims intake process.
The first step in claims management is usually to file a First Notice of Loss to inform your insurance provider that you’ll be making a claim. For workers’ comp, you may also need to file a First Notice of Injury with the Occupational Safety and Health Administration or the relevant board in your state.
Pulpstream makes it easy to initiate the claims intake process with a self-service portal and customizable forms and templates. You can even generate an FNOL automatically based on information you’ve already entered into the system.
Next, you’ll need to gather evidence to support your claim. This could take the form of an accident investigation or interviews with witnesses. Even though your insurance company may conduct their own investigation, it’s a good idea to be proactive and collect as much evidence as you can to present your side of the story.
Pulpstream’s incident management tools do just that — storing photos, video recordings, and other evidence all in one centralized location so it’s there when you need it.
The next step in the process is validation, in which the insurer verifies that the claim relates to a valid insurance policy. For medical claims, this may involve matching an employee’s name, date of birth, and other details to their healthcare coverage.
For business insurance claims, you’ll need to determine which type of policy it falls under (i.e., product liability vs. general liability) and who was at fault.
Now, your claim will progress to the adjudication process, in which your insurance adjuster (or in some cases, a judge) determines how much to pay out. A successful claim may provide workers’ compensation or partial wage replacement to an injured employee. If a claim is denied, you may have the opportunity to appeal it.
Use a claims management platform like Pulpstream to automatically follow up with stakeholders and let them know the outcome of their claim.
Waiting on the outcome of a claim isn’t just stressful for your business or your injured employee — it can mean less money in your bank account. An efficient claims intake process can save you time and money in three key ways.
First, avoid delays in claims processing by collecting all of the information your insurer will need upfront. Insurance claims often go through a triage process, in which your insurer decides how to prioritize incoming claims. Use automation to streamline the claims intake process and increase the likelihood of a fast approval.
Mistakes in the claims intake process can lead to a claim being denied or delayed. A missing birth date, policy number, or medical form can jeopardize the outcome. Use Pulpstream to automatically fill forms with employee data that you already have to reduce the likelihood of duplicate claims, missing data, and other human errors.
One of the best things about digitizing your claims intake process is that you can store all of your paperwork in a secure, cloud-based platform and even collect e-signatures online. Pulpstream’s comprehensive case management tools allow you to treat each claim like the unique case that it is and upload data from almost any device.
The claims intake process involves filing an FNOL and gathering the information you need to provide to your insurer. An efficient claims intake process can help you avoid delays and provide a smooth claims experience to stakeholders, such as an injured employee or a third-party making a business liability claim.
Modern claims management tools use intelligent document processing to scan or convert documents into the appropriate format and organize claims data. You can even use data analytics to monitor trends related to your business insurance claims.
Pulpstream’s no-code platform allows you to track insurance claims, manage incident investigations, and monitor claims analytics all in one place.
Request a demo today to see it in action!