For many insurance companies, the challenges involved in processing claims are ongoing. Because claims often involve multiple decisions, data from various sources, and task handoffs, it's clear why carriers see the potential for improved customer service and financial results from streamlining manual claims processing.After recognizing many opportunities to automate its manual processing decisions, Blue Cross and Blue Shield of North Carolina (BCBSNC), headquartered in Durham, decided to dive right in. "We process more than 30 million claims annually, and about 12% have to be manually handled in some fashion," explains Sherman Owens, BCBSNC vice president, quality and compliance. "As you can imagine, there's a lot of costs associated with that."
As BCBSNC execs began looking at various options to relieve some of the manual work, they first examined their claims process. The company decided to try to automate evaluation of associated claims information to determine if it should pay claims that were suspended through an existing adjudication system.
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