What is Claims Process Automation ?

Claims process automation is the use of technology to automate the handling and processing of healthcare and insurance claims. This technology enables insurers to streamline their claims processes, reduce manual work, and improve efficiency. Automated claims processing software uses machine learning, artificial intelligence, and natural language processing to collect and analyze data from various sources, allowing insurers to process claims faster and more accurately. Claims process automation also provides benefits such as cost savings, better customer service, improved data accuracy and security, and reduced risk of errors and fraud.

How Claims Process Automation Works

We will now paint a picture of how an end to end fully automated claims processing workflow looks like. A lot of establishments selectively incorporate certain aspects of this workflow into their operations, while others adopt the fully automated workflow end to end.

This is followed by a collated list of the best businesses offering each aspect of the claims process workflow for you.

Here is a step-by-step overview of how claims process automation works –

  1. Initial claim reporting: The process begins when a policyholder reports a claim to the insurer. In many cases, this can be done through an online portal or mobile app. The policyholder provides basic information about the claim, such as the date and location of the incident, and any supporting documentation or images.
  2. Claim assessment: Once the claim is reported, the insurer uses automated tools to assess the claim and determine whether it is covered by the policy. This may involve analyzing the policy language, reviewing the reported damages, and consulting with third-party databases to verify the claimant’s identity and prior claims history.
  3. Claim validation: If the claim is deemed valid, the insurer will begin the process of validating the claim by gathering additional information, such as medical records or repair estimates. This process can also be automated, with software pulling data from various sources and using AI algorithms to assess the validity of the claim.
  4. Claims decision-making: Based on the information gathered during the assessment and validation stages, the insurer will make a decision about the claim. This decision can also be automated, with the system applying predefined rules to determine the appropriate payment amount or coverage level.
  5. Payment processing: If the claim is approved, the insurer will initiate payment to the claimant. This may involve automating the payment process through electronic funds transfer or other digital payment methods.
  6. Claims analysis: Finally, the insurer may use automated tools to analyze the claims data to identify patterns and trends that can be used to improve claims processes and reduce fraud.

Business Offering These Services –

Here are some examples of companies that offer services for each step of the claims process automation:

  • Initial claim reporting:
  1. Snapsheet: Offers a digital claims platform that allows policyholders to submit claims online or through a mobile app. https://www.snapsheetclaims.com/
  2. Guidewell: Provides a digital platform for health insurance claims management that allows policyholders to submit claims and track their status online. https://www.guidewell.com/
  • Claim assessment:
  1. Shift Technology: Uses AI algorithms to analyze claims data and detect fraud, errors, and anomalies. https://www.shift-technology.com/
  2. Casentric: Provides a claims management platform that uses predictive analytics to identify potential issues and speed up the claims process. https://www.casentric.com/
  • Claim validation:
  1. Nanonets: Nanonets OCR can help automate the process of validating claims by extracting key information from claim forms, such as policy numbers, claimant names, and damage descriptions. The system can use machine learning algorithms to analyze the extracted data and flag any potential errors or inconsistencies. This can help insurers process claims more quickly and accurately, reducing the time and cost involved in manual validation.

Looking to automate Claims Processing? Look no further! Try Nanonets Claims Processing Automated Workflows for free.


2. Verisk Analytics: Offers a suite of tools for claims validation, including property and casualty claims analytics, medical bill review, and workers’ compensation claims management. https://www.verisk.com/

3. ClaimGenius: Uses computer vision and AI to automatically assess vehicle damage and generate repair estimates. https://www.claimgenius.com/

  • Claims decision-making:
  1. Nanonets: Nanonets OCR can be used to automate the process of claims decision-making. For example, the system can extract data from repair estimates, medical bills, or other documentation, and use machine learning models to determine the appropriate payment amount based on predefined rules. This can help insurers make faster and more consistent decisions, while also reducing the risk of errors or bias.
  2. Octo Telematics: Provides telematics-based solutions that allow insurers to monitor driving behavior and calculate premiums based on risk. https://www.octotelematics.com/
  3. Tractable: Uses computer vision and AI to automatically assess vehicle damage and determine the appropriate repair costs. https://tractable.ai/
  • Payment processing:
  1. Checkbook.io: Offers a digital check platform that allows insurers to issue payments electronically and securely. https://checkbook.io/
  2. PayPal: Provides a range of digital payment solutions, including online and mobile payments, that can be used for claims processing. https://www.paypal.com/
  • Claims analysis:
  1. EXL Service: Offers analytics solutions that help insurers analyze claims data and improve their processes. https://www.exlservice.com/
  2. Mitchell International: Provides claims management and analytics software for the automotive and workers’ compensation industries. https://www.mitchell.com/

Benefits of Automating Claims Processing

  1. Increased Efficiency: Automation reduces manual work, increases speed, and streamlines the claims process.
  2. Improved Accuracy: Automation reduces the chances of human error and improves accuracy in claims processing.
  3. Faster Turnaround Times: Automated claims processing allows for quicker turnaround times, which can improve customer satisfaction.
  4. Better Customer Service: Faster claims processing times, better accuracy, and quicker responses to customer inquiries can all improve customer service.
  5. Reduced Costs: Automation reduces the need for manual labor, which can reduce costs and improve profitability.
  6. Enhanced Compliance: Automation can help ensure compliance with regulatory requirements and reduce the risk of fines and penalties.

Claims Process Automation with Nanonets

Nanonets OCR is an AI-powered optical character recognition technology that enables companies to extract information from unstructured documents such as invoices, receipts, and insurance claims. Healthcare and insurance companies can leverage this technology to automate their claims processing, thus reducing manual errors, minimizing processing time, and improving customer satisfaction.

Let us explore some specific use cases with examples on how insurance and healthcare establishments can further use Nanonets OCR for claims process automation.

Insurance Claims Processing

Insurance companies receive a large volume of claims every day, which need to be processed quickly and accurately. However, claims processing is a time-consuming and error-prone task, often requiring manual data entry and verification. By using Nanonets OCR, insurance companies can automate their claims processing, reducing processing time and minimizing manual errors.

For example, an insurance company may receive a claim for car damage caused by an accident. The claimant submits an image of the invoice from the repair shop. The insurance company can use Nanonets OCR to extract the relevant information from the invoice, such as the repair costs, date of repair, and the name of the repair shop. This information can be automatically fed into the claims management system, which can then process the claim faster and more accurately.


Looking to automate Claims Processing? Look no further! Try Nanonets Claims Processing Automated Workflows for free.


Healthcare Claims Processing

Healthcare providers often deal with a large number of insurance claims, which need to be processed quickly and accurately. Nanonets OCR can be used to automate the process of extracting data from medical bills, insurance claims, and other related documents. This can help healthcare providers reduce manual errors and speed up the processing of claims.

For example, a hospital may receive an insurance claim for a patient’s surgery. The hospital can use Nanonets OCR to extract the relevant information from the claim, such as the patient’s name, date of surgery, type of surgery performed, and the cost of the procedure. This information can be automatically fed into the hospital’s claims management system, which can then process the claim faster and more accurately.

Two-Way Matching

Another use case for Nanonets OCR in insurance and healthcare companies is two-way matching. This process involves matching data from two different sources, such as an invoice and a purchase order or a medical bill and an insurance claim.

For example, an insurance company may receive an invoice from a healthcare provider for a patient’s treatment. The insurance company can use Nanonets OCR to extract the relevant information from the invoice, such as the patient’s name, date of treatment, and the cost of the procedure. The same information can also be extracted from the insurance claim submitted by the patient.

By using two-way matching, the insurance company can compare the information extracted from the invoice and the insurance claim to ensure that they match. This can help to identify any discrepancies or errors, enabling the company to resolve any issues before processing the claim.

Verification of Policy Documents

Insurance companies often receive policy documents from their customers, which need to be verified and processed. By using Nanonets OCR, insurance companies can automate the process of extracting information from policy documents, reducing manual errors and speeding up the verification process.

For example, an insurance company may receive a policy document from a customer, which needs to be verified. The company can use Nanonets OCR to extract the relevant information from the document, such as the customer’s name, policy number, and the type of policy. This information can be automatically verified against the company’s database, reducing the time and effort required for manual verification.

Verification of Medical Records

Healthcare providers often need to verify patient medical records for insurance claims and other purposes. By using Nanonets OCR, healthcare providers can automate the process of extracting data from medical records, reducing manual errors and speeding up the verification process.

For example, a healthcare provider may need to verify a patient’s medical history for an insurance claim. The provider can use Nanonets OCR to extract the relevant information from the medical records, such as the patient’s name, medical conditions, and treatment history. This information can be automatically verified against the insurance company’s database, reducing the time and effort required for manual verification.

Start Automating Claims Processing Today

Nanonets OCR is the best way to start automating claims processing. This technology can be used to automate the process of reading and processing claims documents, which can be time-consuming and error-prone when done manually.

Benefits of adopting Nanonets have been seen for multiple clients already –

  1. Fast and accurate data extraction: Nanonets OCR can extract text data from claims documents quickly and accurately, reducing the time and costs associated with manual data entry. This technology can also reduce the risk of errors that can occur during manual data entry, improving data accuracy.
  2. Improved processing times: By automating claims processing with Nanonets OCR, claims can be processed faster and more efficiently. This can reduce the time it takes to process a claim, which can improve customer satisfaction and reduce costs associated with manual processing.
  3. Automated claim classification: Nanonets OCR can also be used to classify claims based on specific criteria, such as claim type or severity. This can help insurers prioritize claims processing, ensuring that urgent claims are processed first.
  4. Fraud detection: Nanonets OCR can be used to detect potential fraud in claims documents by identifying inconsistencies or anomalies in the data. This can help insurers prevent fraudulent claims and save costs associated with fraudulent activity.
  5. Better customer experience: By automating claims processing with Nanonets OCR, insurers can provide a better customer experience by reducing processing times and improving accuracy. This can lead to increased customer satisfaction and loyalty.
  6. Reduced operational costs: Automating claims processing with Nanonets OCR can reduce the costs associated with manual data entry and processing. This can result in significant cost savings for insurers, which can be passed on to customers in the form of lower premiums or improved benefits.

One of our AI experts at Nanonets can get on a call with you to discuss your use case, set up your model and provide a demo within 15 minutes.


Looking to automate Claims Processing? Look no further! Try Nanonets Claims Processing Automated Workflows for free.


Source: https://nanonets.com/blog/claims-process-automation/