Executive Summary / Abstract
The objective of the project was to implement a process-oriented architecture including the standardization and improvement of user interface ergonomics. The goal was to raise the degree of automation in claims processing to absorb an annual increase in gross revenue by 10-15 percent with an equal increase in claims, as well as to relieve clerks of simple routine tasks.
The annual increase in gross revenue could be absorbed by automated claims processes, which meant that the number of experts needed for processing was almost stable. This is an equivalent of € 0.75 million in cost savings per year and rising. In addition, the implementation of a rules engine for regulatory rules resulted in an increase of one percent in claims rejection or over € 1.65 million per year and growing. Claims processing time could be reduced from an average two weeks in the past to a few hours. The new automated process frees claims experts from routine tasks and lets them work on unclear or complex cases. On the other hand, simple tasks as obtaining missing data or correcting errors can now easily be diverted to less qualified personnel.
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