Identify the Ideal Routing Rules for Moving Claims

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Case Study # 2 from the recently published eBook

Our Story of Claims Routing:

Tonya had always been proud of her role as the head of operations

at DentaCare Insurance. The company had grown rapidly, and to

manage costs, they had implemented a system where most dental

claim receipts were routed offshore for processing after being

indexed with a claimant number.

One day, Tonya noticed an alarming trend. Customer complaints

were on the rise, and the claims department seemed to be constantly

scrambling. She decided it was time to take a closer look at

their processes. which she knew would be difficult given complex

workflows, data, and bias that can go undetected.

Tonya brought in a team of process mining experts. As they dug into

the data, a pattern emerged. Certain types of claims were frequently

being sent back to North America for reprocessing. These complex

cases were causing bottlenecks and frustrating both staff and customers.

We’re only successfully processing 60% of claims on the first try,”

Tonya explained to the board. “We need to make a change.” <<Read More>>

How Process Intelligence Helped

1. Routing rules are difficult to access until you correlate the sequence of activities with outcomes over 1,000’s of claims

2. Often, 20%+ of claims bouncing back from offshore or BPO teams resulting in multiple touches and rework were identified

3. Within 60 days, an assessment using process mining was able to identify changes that can be implemented immediately, often without IT involvement

Check out the table of contents for the rest of the claims stories

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Celonis is your gateway to Process Intelligence

About Celonis

Since 2011, Celonis has helped thousands of the world’s largest and most esteemed companies yield immediate cash impact, radically improve customer experience, and reduce

carbon emissions.

Its Process Intelligence platform uses industry-leading process mining technology and AI to present companies with a living digital twin of their end-to-end processes. For the first time, everyone in an organization has a common language for how the business runs, visibility into where value is hiding, and the ability to capture it.

Celonis is headquartered in Munich, Germany and New York City, USA with more than 20

offices worldwide.