Insurance process optimization: 4 Steps to increase profitability

by Dr. Michael Skiba

Insurance claims consume nearly 80% of insurance company‘s premiums in the form of payments, fraudulent losses, and processing costs. Therefore, insurance companies are justifiably concerned about optimizing the claims process but are often unsure about the most effective method to accomplish this. ​

Effectively managing this optimization can be challenging, this is where Insurance Process Optimization (IPO) services can help you. This unique approach will provide expert consultation on the most effective method to streamline claims and Special Investigative Unit (SIU) processes. Our leading experts will perform intricate analysis and look for opportunities to fill the “gaps” in a company‘s current processes. IPO services can optimize existing workflow across all lines of business and suggest new, exciting methods to increase operational effectiveness. Unlike rigid “out of the box” optimization systems, IPO services provide a highly strategic and flexible solutions based process that will fit within a company‘s unique strategic approach. Partnering this flexible approach with an award winning intelligent routing system like RiskShield will undoubtedly unleash the business value through streamlining of the claims process.

  1. Increase the productivity by intelligent claim routing utilizing RiskShield or any existing software system. In an example of one of our customers, we helped them determine that between 70-90% of their claims were routed improperly, which had resulted in millions of dollars lost from wasted employee resources. Through IPO services we increased productivity through proper claim routing, which resulted in faster settlement.
  2. Increase customer satisfaction and loyalty by optimizing the time it takes to settle a claim by filling in informational gaps in claims reports. A lack of basic information in first claim report results in delays of 3-5 days in the settlement process. IPO services offer assistance with optimizing existing informational processes. On the other hand, we can provide expert outsourced services to assist with this basic, yet highly significant task. This “back office” assistance will allow the claims staff to focus on core operational strategies instead of secondary tasks.
  3. Decrease operational costs by providing a streamlined fast-track and low exposure settlement option. We discovered that one of our customers had upwards of 50% of their overall claims that could be settled with a cheap, fast-settlement option, saving valuable time. IPO services offer expert workflow management through process re-design or outsourced solutions. Both of these approaches will allow adjusters to focus on core processes and customer loyalty, both key elements of highly competitive insurance companies.
  4. Decrease loss exposure and risk by SIU support for existing fraud processes or fully managed outsourced expert SIU units to assist with newly recommended counter fraud areas. These new recommendations come in the form of Intelligent Handling Protocols (IHP) which are proven counter fraud processes. For example, IPO services offer an IHP for Minor Impact Soft Tissue fraud cases that result in mitigated or denied claims 95% of the time. We also have highly effective IHP‘s in the area of medical provider fraud.

A pilot test performed on one of our customer databases showed that upwards of 35% of all claims submitted had some signs of suspicion in the area of medical billing fraud.
For these reasons, IPO services provide process optimization with a track record of success. IThrough expert consulting, technological support, and a fully configurable process, IPO services will assist you with increasing customer loyalty, reducing claims operational costs, increasing savings, and ultimately creating a more competitive, profitable company.

Download the PDF report here.

This blog was originally posted on the RiskShield blog.

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About the author

  • Dr. Michael Skiba

    Dr. Skiba (also known as “Dr. Fraud”) has worked in the insurance fraud industry for 22 years in various claims, Special Investigations, and leadership roles. He is currently Vice President of Counter Fraud Strategies at INFORM. He has also been a professor for 12 years and is currently Lead Faculty of Fraud Management at Colorado State University Global Campus. He is an international speaker and regular publisher on the topic of insurance fraud. He holds an MBA and a PhD with a concentration on economic crime and insurance fraud. He is also the President of the NY Chapter of the International Association of Special Investigative Units.

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