Snapshot
Company: ICICI Prudential Life Insurance
Project: SOA-enabled Web-based health claims
processing application
IT Head / CIO / CTO / Project Lead: Chaya
Pisupati, Senior VP, IT
Processing a health claim is
time-consuming and complex, as it involves a number of
stakeholders. To simplify this process, ICICI Prudential Life
Insurance created a scalable web-based integrated system that can
be used by all third parties such as Network Hospitals, clinics and
third party administrators (TPAs) for servicing health claims and
life claims.
The prime objective is to reduce the turnaround time for claims
processing and also provide automatic rules-based decisions in
terms of payout and claim
adjudication.
Integrated tightly with SMS, e-mail
and document management systems, the application enables real-time
communication with the customer and third party administrators
involved at various stages of the claims processing
process.
Today, as a result of this solution, the TPA gets access to updated
information and is in a position to fulfill a claims request within
hours, rather than days. Besides improving the claims processing
accuracy, the time taken for cashless claims decisions has reduced
from eight hours to two hours primarily because it has minimized
the manual handling of claims forms and
documents.
A centralized process has helped in
gauging hospital credential ratings, to help in arriving at the
right cost decisions, while customer communication at all stages of
the claims lifecycle has helped in improving customer satisfaction.
The solution is also equipped with a robust workflow facility to
auto allocate claims cases to respective assessors, leading to a
boost in employee productivity.
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