Reduce Claims Mis-assignment and Reassignment in FNOL

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Case Study # 1 from the recently published eBook

Our Story:

It was another busy day at the claims processing center for a major Midwest insurance carrier. Claim files were piling up, and adjusters were scrambling to investigate and resolve each case as quickly as possible. However, one glaring issue had management's attention – the alarmingly high rate of re-assignments for complex claims. On average, each case was being passed around between four different adjusters before reaching a resolution.

Determined to get to the root of this inefficiency, the carrier's leadership decided to take a deep-dive into their recorded first notice of loss (FNOL) calls. By transposing these initial claims recordings into their Celonis process mining platform, they could analyze the data for patterns and potential issues in their procedures.

What they uncovered was eye-opening. Their analysis revealed that the Northeast region's call center representatives were consistently failing to ask critical questions about the medical conditions of drivers and passengers involved in accidents. This lapse in information gathering was leading to incomplete claims files that required multiple re-assignments and requests for additional details.

Armed with this newfound insight, the carrier swiftly implemented revised call scripts and comprehensive training programs. Call center staff in the northeast were retrained on the importance of thoroughly documenting all relevant medical information during that crucial first notice of loss. With these improved processes in place, the carrier was able to drastically reduce the number of re-assignments for complex claims, streamlining their operations and providing better service to their customers.

In addition, they were able to use process intelligence to monitor and control the desired actions, and react in real-time to address non-compliance work steps as they happen in the claims process.

How Process Intelligence Helped

1. Discovered which types of claims are getting mis-assigned

2. Identify root causes such as missing information (questions not asked) in FNOL

3. Understand just how dramatic re-assignment impacts customer satisfaction (due to asking for the same information at each step in the process)

Key Claims Statistics

• The cost of new scripts and training was less than $50,000.

• Reassignments average dropped to 2.1, saving $1,240,000 in rework

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

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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.