For more than 50 years programmers have been building routines to automate manual processes.  Automation is prevalent in almost every business process including claims processing.  Adjudication systems can process about 75% of the claims submitted to a health insurance company.  That means about 25% still have to be touched by a human.  According to AHIP the cost of processing claims manually is $3.00 higher.  That adds $3.6 billion a year to our health care costs.

The reason these manual activities have not yet been automated is simple.  There are hundreds or even thousands of processes required to settle a claim.  Most of them are not complex but they must be automated correctly.  That type of automation is not easy for traditional development efforts.  Image an automobile manufacturer building hundreds of different types of cars in the same factory.  It is not cost effective.  Instead automobile components are built and shipped to assembly lines for final production.

Automating claims should be similar.  Reusable components need to be built and then assembled together to create the automation necessary to replace a manual process.  The more discreet the components, the higher the reusability factor.   Agile development lends itself to component development but it is not enough.  To cost effectively develop claims automation a powerful integration tool and a powerful automation engine must be combined.  When this is done claim automations (repairs) can be scoped, designed, built and tested in just a few days.

These tools, combined with the right techniques and claims expertise allow us to build effective claims automation and reduce that $3.6 billion wasted expense.

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Perhaps Henry David Thoreau was right – especially when it comes to the contact center. 

To make significant performance improvements in your contact center, you must address the individual agent processes that occur hundreds or thousands of times each day.  All too often, the technology & business processes put in place can become barriers to the worker’s ability to execute. You need a means to remove these barriers and create efficiencies using automation to eliminate redundant data entry and manual processes. Let the computer do what it does best – automate processes – and let the agent do what he or she does best – service the customer!

On most desktops in the contact center, agents interact with numerous systems that contain customer data.  Across these applications, agents still copy and paste from screen to screen, toggling between systems, which can add up to enormous amounts of wasted time.  This manual work can frustrate the agent – or worse – the customer.

Another side-effect of copying and pasting from screen to screen and system to system is the likelihood of errors occurring. Agents could paste incorrect information into certain fields, which could result in incorrect billing, payment, or order fulfillment, which in turn negatively impacts the customer experience.

Why make the customer wait while agents rekey or copy and paste customer data into numerous systems? Instead, automatically push the data to all your contact center agent software applications simultaneously.

Creating a better workflow using process automation will improve agent satisfaction, reduce training needs and reduce or eliminate errors. This in turn can result in lowered operational costs and minimize attrition in contact center staff. The improved efficiency directly benefits customers, resulting in higher customer satisfaction and improved revenue.

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When it comes to improving the customer experience, companies invest huge amounts of money and time… trying to achieve the next “big” technology advancement or get on the latest trendy bandwagon. Yet, when it comes to taking the first steps to improve customer service, look at the agent desktop and processes… So as far as a day in the life of the agent goes, let’s begin with the start of an agent’s shift. What must every agent do prior to beginning their shift?  Log in. It’s simple, but it can be a complex, time-consuming process.

When you’re talking about 10, 15, maybe 20 applications – this login process is time-consuming, and prevents them from using that valuable time taking calls.  Even worse – they could be on a call with a customer trying to access account information, and because they have timed out of a particular application, they waste time (and frustrate the customer) by having to log back into the system.

Customers want agents to be available when they call. During a call, the customer doesn’t want to endure a wait as an agent tries to remember a password or has to log in again to a system that has timed out. Make your agents available faster at the start of a shift by automatically logging them into all the applications they need, and prevent timeouts by keeping them logged in for their entire shift.

By deploying a single sign-on, you give valuable time back to the agent and the customer.  The agent is able to start the shift faster, avoid untimely “system timeouts,” thereby providing a better experience for the customer and for the agent. The result? More satisfied agents, which translates to higher employee retention.  More satisfied customers – higher customer retention, CSAT and NPS scores, and increased revenue.

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Let’s look at a success story of claims automation.

The Vice President of the our story’s claims shop realized, after years  of failures, he needed to try a new approach.  Instead of working through an elaborate project justification he agreed that automating claims processing would save at least 25 FTEs and maybe as many as 150 FTEs.  Using the low estimate, the project was approved for about $1M for 12 months.

The project director and business architect proposed doing an agile project  to produce value quickly and allow the project to work within the limited duration and budget.  The team was made up of 1 business architect, 2 claims specialist, 3 IS developers, 3 business analysts and 2 testers.  The entire team was co-located within the IS shop.

The team delivered their first iteration of automation in 60 days eliminating the work of 12 Claims Examiners.  For the next year the team delivered new automation every 30 days eliminating the work of 110 FTEs saving over $8M.  Besides the 800% ROI there were also some lessons learned, including:

• Utilizing the agile development methodology
• Building a requirements backlog
• Delivering small changes iteratively
• Rethinking traditional SDLC principles

Do you have similar experiences?  What are the two or three factors that ensure the success or failure of a project?  Post your stories and lessons learned.

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