Claims processing has become one of the most expensive, complex and resource-intensive processes in the insurance industry. Traditional health care claims processing systems, comprising core enterprise applications and databases located throughout the enterprise, can't keep up with today's ever-shifting market where customers are in the driver's seat.Competitive pressure demands insurers offer more flexible products and more responsive services. But claims processing systems aren't geared to support them. They were designed in the one-size-fits-all era when change occurred slowly. As a result, every change is a major undertaking.
The results are significant claims backlogs, low first-pass adjudication rates and sub-optimal processing statistics-all resulting in $3.2 billion wasted every year on this cumbersome process.
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