Coforge transforms back-office operations for American Insurance giant.
Overview.
Our client is a Fortune 500 American insurance company serving more than 50 million people worldwide. It is the largest provider of supplemental insurance in the United States.
The back-office team was operating at an AHT of 24 min against a requirement of 9 min to process a claim. The team’s productivity was not sufficient to meet the target for minimum daily transactions committed to the client. The client had 69 processes overall. Non-standard IT processes were being followed, compounded by manual processes due to lack of application integration. The data was distributed across multiple sources (systems, spreadsheets, templates, PDFs). There was insufficient staff especially during peak hours. There were no defined KPIs/SLAs or metrics. A quality framework was missing, and the cost of quality was not known.
Solution.
Coforge undertook a 4-week study where the team understood the processes, operational issues and challenges. We conducted data and trend analysis and monitored reporting and monitoring mechanism was deployed. We also identified additional opportunities to improve overall claims processing. Coforge also did the following:
Implemented a scalable solution over a 6-month timeframe that incorporates AI, ML and RPA to automate services.
Implemented a volume-based managed service operating model that focuses on outcomes (i.e. is not resource based).
Setting up offshore simple processes thereby enabling client experts to focus on (a) value-add work & (b) help implement transformations.
Building up short term solutions that address/mitigate critical risks & issues. This includes implementation of a quality framework, SLAs/KPIs along with offshoring of low complexity work.
A long-term strategic solution that can support future growth aspirations while mitigating all key risks.
A total of 15 opportunities were identified and categorised across- People, Process and Technology.
Coforge made the following recommendations:
Enable categorization of incoming claims through system or pre-processing team to allow creation of an operating model based on skill, experience and claim benefit category
Keyword based search utility to fetch information from multiple data sources (SharePoint, Websites, Documents)
Utility to help construct the outgoing letter contents based on the pending and denial reasons
Improve indexing to minimize inconsistency in orientation, scan quality and blank pages
Implement a quality policy along with error categorization, RCA and refreshers for bottom performers
Claims submitted through web & mobile should come as digital forms where information can flow to Pega
Standardized mechanism or tool for recording team productivity and utilization
Enable reporting access in Pega for the offshore team
The impact.
Nearly 40+ processes were automated through RPA, Macros, Scripts, minor changes, modifying current application, OCR etc.
Introduction of new recon tool enabled automation and hence 90% more efficient matching of all portfolio cash balances and items along with data analysis.
Dashboard showcasing real time data sets and KPIs enabling transparency and data-driven decision-making.
Estimated cost savings of 45% over a 5- year duration.
90%
more efficient matching of all portfolio cash balances and items along with data analysis.
45%
estimated cost saving over the past 5 Years.
40+
nearly processes were automated through RPA, Macros, Scripts, minor changes, modifying current application, OCR etc.
