Identify the Ideal Routing Rules for Moving Claims
- Rick Tucker
- Oct 8, 2024
- 2 min read
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
Routing rules are difficult to access until you correlate the sequence of activities with outcomes over 1,000’s of claims
Often, 20%+ of claims bouncing back from offshore or BPO teams resulting in multiple touches and rework were identified
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
Our eBook Partner
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.
