End-to-End Claims Processing Automation for Insurers
AI-powered document identification, accurate information extraction and automatic notifications keep your customers informed while reducing risk and enabling fast decisioning.
Verify and process large volumes of claims data for fast and accurate claims decisioning
A claim lifecycle is made up of 4 key steps: Generating a claim, filing a claim, administering a claim and reporting a claim. The claims administration or processing stage includes pre-adjudication, adjudication and post-adjudication. These, in turn, consist of numerous sub-processes to handle the intake, validation, verification, application of benefits, and resulting response of approval, payment, denial, communication management and explanation of benefits.
Due to the numerous steps, disparate input data and media, legacy systems, these processes are often highly manual, which makes them highly time consuming, prone to errors and expensive, resulting in increased operational costs, reduced speed and accuracy. The Claims Processing Accelerator from TCG Process was developed to significantly reduce the amount of time from claim intake to update by automating different stages in the claims pipeline.
How insurance companies benefit from the Claims Processing Accelerator:
Errors are reduced with proven complex data handling and consistent application of business rules
Seamless integrations with existing claims management and policy administration systems
Processing times are reduced by swiftly identifying and acting on bottlenecks and streamlining approval and review processes
Compliance is ensured through detailed audit logs and validation against defined business rules
Ability to deliver superior customer service by providing timely updates and resolutions to claimants
DocProStar: Ensuring Accurate Information from Any Source
Decades of subject experience underpin DocProStar, transforming the way that unstructured document input is turned into actionable business information. By streamlining the initial processing of documents, DocProStar empowers organizations to achieve unparalleled levels of control, efficiency, and customer satisfaction. This is accomplished through three distinct, yet interconnected process sequences.
Quickly ensure the legitimacy of submitted claims with advanced technology:
Machines learning models analyze and recognize patterns and anomalies in claims data to identify suspicious activities while continuously learning to improve accuracy and effectiveness over time
Automated cross-referencing with internal databases and external sources to verify authenticity of submitted data
Rules-based engines are used to apply predefined rules and business logic to flag claims that do not confirm to typical patterns or established criteria
Content extraction and analysis ensures data integrity while tampering detection and authenticity validation ensure document integrity
“We have been very impressed with the capabilities of the team from TCG Process and their product DocProStar in delivering fantastic results for Honan. You know it's been a great project when many of your colleagues take credit for the results.”
Stuart Madden Head of Technology, Honan Insurance Group (now owned by Marsh McLennan)
Frequently Asked Questions
OCTO provides an open interface for bi-directional integration, making it very easy to integrate existing solutions. All information available via the standard interface portals are exposed through APIs.
Yes, in fact, document handling is the strength of DocProStar, TCG Process’ intelligent document processing solution powered by OCTO. Learn more about DocProStar.
High volumes are easily accommodated through a combination of scalable infrastructure, optimized data processing and intelligent data management, variable volumes are handled with ease. AI-powered automation prioritizes claims, detects fraud and optimizes processes while load-balancing and real-time monitoring prevents bottlenecks.
Implementation times vary based on requirements, but a POC can be up and running in as little as 2 weeks.
With OCTO and DocProStar in control, security and compliance is taken care of without a second thought, every action is captured in detailed audit trails and access to documents is controlled via security roles. In addition, from a technical perspective, all information is encrypted in transit and at rest, ensuring complete peace of mind for even the most sensitive information.
There are a variety of fraud detection and prevention mechanisms that can be applied including anomaly detection, image and document analysis, red flag or geo-spatial rules, duplicate claim detection, human-in-the-loop review and other techniques.
The UI is universally intuitive, adaptable and efficient for all users. A user is able to personalize their view to highlight the most relevant data, fraud alerts and process tasks required to keep things moving. A powerful, easy-to-use search bar and filters allow users to quickly find claims, risk assessments and investigation details. Furthermore, the system will prioritize urgent cases and flag potential fraud. This universal interface ensures that all processing team members – regardless of role – can efficiently navigate claims, detect fraud, and complete tasks with minimal learning curves.