Realizing the Paperless Claims Environment

Online interface between systems and collaboration among users of
different firms, using Internet “hub” technologies could yet reduce the paper chase.

Over the last couple of years the insurance
industry has explored paperless claims environments, though I suggest with little success.
An insurance claims department is, by nature, a file based industry, driven by a need for
documentation, whose files are populated with information created by an external supply
chain. These files are copied/shared among both internal and external interested parties
for purposes of claims handling, management, audits, compliance, customer service, etc.

This creation of paper documentation stems
from a multitude of parties involved in the settlement of a single claim. Multiply that
volume of paper over the thousands of claims generated and one can see the obvious
benefits in any attempt to reduce the volume and administration of paper flowing through
mailrooms and being stored for years. The costs associated with the processing of mail and
other paper before it becomes useful is staggering.

In its infancy, paperless solutions have
involved the introduction of scanning technology, whereby mail, faxes and other
information are input into a generic file catalogue of image documents. These earliest
solutions have changed little today, other than incorporating the ability to upload
documents created on one’s desktop or through a network into a generic filing
catalogue. The relative success of these earliest environments still holds true today; the
quality of the hardware i.e. scanners.

However, the scanning solution fails to
realize the true paperless environment on many levels; incoming mail, the duplicated
storage of scanned paper (since the hardcopy is being received anyway) and overall
functionality, since a scanned image in a catalogue cannot be shared in a secure
environment, which then necessitates the image being printed and copied. Which bring us
full circle, by actually creating more paper and being less efficient about its creation.

Administratively, expenses have increased, as
companies have required support people to operate the scanner throughout the day to try
and keep current with the paper as it is received and not delay the processing of the
claim. However, one must remember that if the solution is corporate wide there is little
chance that claims mail will be prioritized. This has serious implications for a claims
department that has legislated time limits to respond to mail.

My own experience demonstrated the increased
reliance upon administrative support functions to ensure the timely scanning of incoming
mail. This workflow created a need for more support staff, temp support and others while
invoking overtime and scanning “blitzes” to catch up and minimize outstanding
mail. Scanning backlogs have an especially obvious detrimental impact for an Accident
Benefits department already squeezed by legislated response times.

Rather an exhausting endeavor with serious
implications! Am I saying to abandon the paperless solution? No, and in fact I am going to
suggest that we, as an industry, whole-heartedly embrace the concept!

So what is the solution to creating an
efficient, cost effective paperless environment? Collaborative web based technology. What
this means is for the claims department to reinforce relationships with its business
partners, brokers, agents, reinsurers, risk managers and yes even the customer, and allow
them to build the claim file for you.

First, let us look at what a claims department
is in a traditional sense; an insurance claims department is a documentation driven, file
based industry, whose files are populated with information created by an external supply
chain, whose files are copied/shared among both internal and external interested parties
for purposes of claims handling, management, audits, compliance etc.

How does one realize or define a paperless claims environment? I suggest the following:

The paperless claims environment exists
wherein all claims documents, previously created in hardcopy, are securely submitted,
filed/stored and shared electronically without increasing administration and without
reliance upon replicated scanning.

How is this done? By creating a virtual claim
filing system that provides the linkage for all of the parties to create their reports and
associated documents on their desktop and uploading directly into the claim file, thus
eliminating the scanning step and the inefficiencies that go along with it.

Drilling into this definition, a paperless
environment involves taking the documentation as created at source electronically, as a
data processing form, in a word processing document, as a digital image, etc, and
submitting or uploading it directly into the claim file either in its original form or as
it would have been previously printed.

The majority of information contained in paper
claims file is created electronically. A true paperless system eliminates the need to
print or create a hardcopy version of this information, thus eliminating any scanning and
storage of the hardcopy that currently exists in deficient paperless environments.

This process further decreases the
administration that occurred in a scanning environment and in a traditional mailroom model. The volume of
paper will reduce dramatically, and may eventually be eliminated in the claim department.

This model increases productivity as
documentation is received in the claim file moments after its creation and allows for
greater customer service as the adjuster or vendor works proactively, rather than
reactively, towards the resolution of the claim.

Not only can documents be uploaded, but also
digital images, video and even records from the myriad of niche oriented technology
solutions being used to address contents replacement, estimating appraisals, litigation,
salvage, repairs and many others. Where these generate paper in the end, it too can be
incorporated into the virtual claim file.

Not only have you eliminated the scanning but
also you are now working in an environment that capitalizes on collaboration. Through the
sharing of documents, images and all claims information, the need to print scanned images
or make multiple copies of file information is reduced. To upload or share information the
user creating the documentation attaches permissions that determines who may access the record.

This is very powerful from the perspective of
file reviews and audits that regularly occur. The audit process usually requires either a
copy of a claim file or the original to be removed from the front line adjuster thus
detracting from an efficient and productive office environment.

By granting the appropriate permissions,
information can be accessed anywhere at anytime by those that need it. Imagine being able
to centralize functions in head office and from there being able to view a catastrophe
within minutes and scope a loss that occurred in another country or continent.

Suffice it to say that in a claim environment
it is not sufficient to be paperless internally. For a true paperless claims environment
to be realized, the solution must be able to capture external documentation at, or close
to, its source. In addition the solution should permit the external exchange and sharing
of information without copying or printing more paper.

The era of the proprietary system is over!
Through the linkage of systems and claims functions, the infrastructure is being created
for all to exchange information and data. This will result in the realization of the true
paperless environment. All the while, such an infrastructure must not restrict one’s
ability to perform across the broad insurance market that involves so many insurers and vendors.

The solution is an open architecture platform
which permits all of the paperless functionality outlined above in a secure collaborative
and communicative environment. It can be the main paperless claim filing system defined by
the claim department, and at the same time the conduit for the supply and service chain to
securely deliver electronic documentation into the main filing system. ClaimCore from
Correlation Technologies is an example of such a solution.

By Scott Knight, Account Executive, Correlation Technologies

Prior to joining Correlation Technologies, Scott Knight
was involved in casualty departments for different insurance companies; with experience in
the management and workflow assessment of one of the earliest paperless claims initiatives
in the industry.

About Correlation Technologies

We provide the insurance industry with the ClaimCore solution that streamlines the information
exchange between all parties involved in a claim while reducing the need for paper based,
phone and fax communications. This allows claims handlers and service providers the
ability to work together more efficiently and gives claims professionals at every level of
the organization the information and power to control their resources, processes and
vendor relationships in real-time. Correlation Technologies is helping drive out the
millions of dollars in unnecessary costs associated with claims processing while
increasing overall claim satisfaction to all parties.