As an insurance buyer, not only one needs to be aware about the benefits of buying insurance, the ease of filing and processing of claims, but also the process an insurance company follows in claims management. It should not happen that buying insurance becomes a cakewalk while claim settlement takes an eternity! Hence it is important for a consumer to do his research in understanding the back-end processes of an insurance company.
Let us help you with the basic detailing of the claims management system (CMS) that an organization needs to implement for a faster, smoother and easier claims settlement process.
For an organization, the basic things it needs to keep in mind before investing in a robust CMS can be:
Efficiency and Responsiveness of Claims Management System
The most important aspect of a CMS is to ensure efficient handling and settlement of claims to make sure the customers are satisfied and there is an overall improvement in the company’s performance. The process starting from the First Notice Of Loss (FNOL) to final settlement should be handled efficiently and accurately and this should include proper filing and maintenance of reports and correspondences for future use. In addition, the system should allow the users to run reports quickly. This shall help to expedite the claims, improve employee productivity and save costs for employers. While selecting a CMS, you should check its performance and responsive using real time environment and real time data to gauge its capabilities.
Security And Confidentiality Of The System
Claims and claimant information should always be kept secured and protected with multi-level access passwords and encrypted data. All users should be allotted individual unique Id’s and passwords with no plain text. At no point of time while changing the password or updating a new password should a user is able to view the old password! That is an obvious red flag and should be taken care of immediately. Data to and from the users should always be encrypted using the standard SSL encryption. Along with these guidelines, user access permissions, level of authority, hierarchy relationships with management, etc. are a must for secured transactions.
Hosting Model Of The System
If the organization has the adequate bandwidth and infrastructure for supporting new application, it should host the CMS, otherwise hire a reputed host for best services. Do make sure while hiring the services that the system is accessible all the time and without any interruptions. Also ensure that the host’s equipment is up to date and there are resources available for data backup in case of an unintended loss.
Integrating outside software like Microsoft Excel and Outlook helps to work with CMS. These new additions give more options for export/import of data and handle individual claims at a faster speed, more efficiently and lead to automation of the entire process. An automated process is best suited for an organization to reduce chances of errors. As the organization grows and risks become more complex, such an integrated system will help in managing claims, eligibility, benefits, reports and notes, etc., so as to settle and close the claims faster and with more efficiency.
Once the organization is satisfied with the system and its performance, the next step is to assess the vendor it is going to use for installing this system. The things to be considered while selecting a vendor are:
Requirement of the client
An organization is working in a dynamic environment which changes on a frequent basis. A good vendor should be able to enhance and update the technological advancements to meet a client’s ever-changing needs. They should be able to integrate systematic changes and software updates seamlessly into the existing system without taking too much of time or causing any obstruction to client’s business.
It is important to do a background check and find out the credentials of the vendor not only from the market, but also from the existing and previous clients. This would help the company to get an insight as to how flexible is the vendor while making changes in the technology, how updated are they with the change in the business environment, etc. References always go a long way in choosing the right vendor as the relationship between an organization and the vendor is going to be an ongoing one and not a one-time affair.
This would vary from company to company depending upon the size and requirements of individual organizations. If a particular CMS is being used by multiple users, the cost of acquiring it will be less than the one made to suit only specific requirements.
These are the broad features to keep in mind while selecting an optimal CMS for an organization.