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INSURANCE

Insurance Automation Is the Antidote for the Pain of Data Issues


The Challenge

Financial transparency is emerging as a key driver of customer satisfaction in the increasingly competitive health insurance industry. A big health insurer had this lesson driven home when issues in reconciling claims data and the resulting member service problems nearly led to the loss of a large employer customer. An out-of-sync claims engine led to incorrect follow-up billing, requiring the insurer to manually address members whose claims had been paid incorrectly or had been completely unpaid.

Members were deeply dissatisfied with their service, and one of the plan’s largest employer groups was preparing to leave. The issue was also creating challenges in efficiently adding new client accounts. 


Our Approach

Identifying, extracting and resubmitting affected transactions was forecasted to take at least two weeks, so we streamlined this process by creating a set of automation tools that used minimal amounts of data to identify out-of-sync accounts. We corrected errors like demographic data mismatches and generated new transactions that brought the systems’ totals into balance.

In addition, we enabled the plan to successfully add several large employer group accounts, with our automated tools synchronizing member-shared accumulator data across multiple claim engines.

Keeping Claims Data in Sync Makes Members Happy

As the healthcare industry’s focus on customer service sharpens, accurate member-facing financial data will be a critical competitive prerequisite. Cognizant’s automation tools for synchronizing shared accumulator data will continue to enable this insurer to deliver high quality member service, streamline administrative performance and ensure data quality and accuracy.

89%

reduction in workforce hours spent on reconciliation

86%

reduction in time for new account onboarding

10%

improvement in accuracy in claims adjudication

Improved

customer retention and satisfaction


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