Claims Processing – How It Can Benefit your Business

MHC Marketing    June 26th, 2019 

Claims Processing Illustration

The insurance industry has a 43% automation potential. Automation might replace or consolidate 25% of the insurance workforce by 2025. This is according to a McKinsey Global Institute report.

As we all know, the insurance industry is quite sensitive. For this reason, it must maintain high accuracy levels. Thus, most claims processes are now automated.

Automating claims processing reduces inaccuracy and inefficiency of manual data input. It also increases customer transparency.

In this write-up, we will discuss how to create automated claims processing and how it may benefit your business. We will also look at the features of good automation management software. Keep reading to know more.

Determining How To Create Claims Processing Automation Software

A business can create insurance claims processing software in two ways. Firstly, it can build it from scratch. Secondly, it can purchase an existing one and customize it.

All in all, the methods should initiate claims from different sources, which include emails, faxes, and mobile phones.

It must also automate the healthcare flow, and especially the repetitive processes. These include claims reporting, vendor management, entitlement tracking, and dispute handling. Besides, the automation should be permissible to third parties.

Features of a Good Automation Management System

It should provide adequate support to all types of insurance claims. It should also integrate well with the various enterprise functions such as policy administration and customer data.

The system must be able to store the historical data per the regulatory requirements of all forms. This includes e-forms and images. In terms of architecture, the system should have three layers configured for the health insurance claims processing automation. The layers are:


Claims are initiated here through various means. The commonly used ways are mobile phones, email, and e-filings.


The claims are reviewed in this layer. Most of the steps are repetitive. In this layer, the management separates the legit claims from the false ones.

The investigation also starts here.


This layer holds all payments and claims before they are taken to different data stores.

Note that the design of the claims automation systems varies from insurance to another. This is because they are designed to meet their specific customers’ needs.

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Benefits Of Automatic Processing To Businesses

Every business intends to keep operating costs low so as to maximize profits. Business automation lowers the costs, and that’s one of the ways insurance companies use to gain a competitive advantage in the market.

But, saving costs isn’t the only thing that gives you resilience among your competitors. Discussed below are the main benefits of claim processing automation:


Performing tasks manually consume much time because humans can only perform a single task at a time.

However, when the claims are automated, the processing time improves dramatically through multithreading and computational power.

Also, automation allows the workers to carry on other tasks and develop new skills to increase productivity.


Automation ensures that tasks are performed well in a sequence and on time. Reliability is increased as the workers’ sickness leave or absenteeism does not affect the progression of work.

When the workers are tired or stressed, their reliability goes down. For instance, according to NCBI, 75- 90% of doctor’s 2 visits are cases related to work stress and ailments. With automation, workers get time to relax and thus increase reliability in the offices.


When you don’t have to access every single claim manually, you can downsize your claims department personnel.

Reducing your employees means that you will spend less on salaries and remunerations.

You will also not require more employees, and thus save on the money spent on recruitment. Automation also saves you overhead costs, as you will need less equipment and supplies.


The traditional claims process is invisible to consumers. Most clients only see the results during reimbursement. This creates a feeling of uncertainty and ambiguity.

However, the advanced claims processing system provides this information openly.

Clients are given a flowchart where they can track the claim process. Also, the dashboard keeps them informed with real-time updates. This improves customer visibility.


Automation increases efficiency. It also speeds the time spent to serve a customer. When the clients are served within a short period, and the data is accurately kept, they will be satisfied.

The satisfaction leads to loyalty, and thus, they increase their trust in your insurance company. Moreover, a satisfied customer can bring you more customers to your business through referrals.


Manual claims processing takes the employees a long time to complete. This is, however, not the case in an organization with claims automation.

It saves time and creates a room for the insurance company to grow and expand into other segments.

The workers’ skills and workforce are also utilized in the sectors to promote business growth.


A lot of paperwork is involved in the claims process. Insurance companies keep the papers for future reference. However, handling them is quite hectic and hard to maintain.

With the increasing methods of automation in the claims industry, physical archives are finally becoming obsolete.

The electronic devices are easier to maintain, and they keep the offices clean. Also, electronic devices do not occupy large amounts of space as compared to papers.


Claims processing automation reduces the impact of human errors. This improves the monitoring and tracking processes.

With correct tracking, it’s easy to make future sales forecast.

These insights allow businesses to make informed decisions and also compile accurate customer experience and insurance results based on the data they collect.

Getting Started

Advancement in insurance technology has improved business performance. Unlike before, customers can now get quality services within a short period. Also, insurance companies can now maximize profits and minimize operating costs.

If you have not yet automated your claims processing, worry not. You can still do it and watch your business grow.

Contact MHC today to build the best software for your company at a reasonable price. With more than one thousand customers worldwide, we have proven agility and functionality. Our excellent customer care team will advise you on the available options.


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