Improving Manual Claims Processing

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How insurance companies can improve the accuracy and productivity of their manual claims processing operations. With Enkata, claims payers get visibility and insight into how their claims processors are working. They can identify and remove the causes of errors and lost productivity. They can ensure process compliance. They can determine best practices for claims payers.

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Improving Manual Claims Processing

  1. 1. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIALInsight. Action. Results.Improving Claims ProcessingUsing Enkata to Improve ManualClaims Processing1
  2. 2. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL2> Productivity Isn’t Where It Needs to Be> Skill and training gaps> Work habits> Process and technology issues> Surveys show manually adjudicated claims cost more than $6 each> Accuracy Isn’t Where It Needs to Be> Error rates on poor processors may be >10%> Underpayments = complaints and rework> Overpayments = lost money, and few are caughtClaims Payers Have Two Problems
  3. 3. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL3> Managers have limited visibility into how claimsprocessors work> What their work habits are> Where they are struggling> If targets are set correctly> Employees have limited visibility into how to work> What is the best process for a claim type> What are the tricks the best people use to be productive> “Am I doing this right?”The Root of Problem: Lack of Visibility
  4. 4. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL4> “Managing by Metrics” Isn’t Managing> “Claims per Hour” doesn’t tell you if they are following the rightprocess> Just knowing the metric gives no insight into how to improveperformance.> If metrics are compared to past average instead of potentialperformance, you’re capping your potential at average.High Level Metrics Don’t Help
  5. 5. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL5> “At a Glance” understanding of claims processors> How they work> What drives quality and productivity> What specific actions can help them improve> Process Analytics for Claims Payers> What steps lead to higher quality?> Which steps are people skipping?> Have the best people figured out a better way to do things?> What mistakes are most common?Enkata’s Solution Starts with Visibility
  6. 6. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL6> More Granular Data> Views from Month-to-Month performance down to the specificsteps taken to process every single claim> Easiest to Understand> At-a-Glance reports tell managers and processors everythingthey need to know to understand performance> Flexible Analytics for Data Scientists> Enkata captures and creates data about claims processing, andthen provides a free form analytics environment that lets datascientists explore the data, find deep insights, and understandeverything about manual claims processingEnkata’s Solution for Claims Payers isCompletely Different
  7. 7. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL7> Identify and Eliminate the Behaviors that Lead to Errors> Enkata delivers understanding into error prone workplacebehaviors including target shooting, multi-tasking, thrashing andexcess pending> Identify and Enforce Process> Processors may be skipping the annoying steps that keepaccuracy high. With Enkata, you can see who is taking shortcuts, and tie that to the accuracy issues you’re trying to fix.> Identify Exactly Where People Need Help> Even generally good processors may have issues or makemistakes with certain types of claims. With the visibility deliveredby Enkata, managers can see where people struggle and needextra coachingEnkata Improves Claims Accuracy
  8. 8. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL8> Eliminate the behaviors that lower productivity> Excess email and IM, idle time and black list internet, and otherbehaviors that detract from production> Eliminate the Problems that Hold People Back> Employee skill gaps, technical bottlenecks, incorrect training> Set Targets Based on Potential, Not Historical> Most claims payers set productivity targets based on productivitylevels they’ve seen in the past, not on what an individual shouldbe expected to produce in a time period.> Replicate the Best Practices of Top Performers Acrossthe GroupEnkata Improves Claims Payer Productivity
  9. 9. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL9> Map Different Practices to Understand How DifferentGroups of Workers Perform> Discover best practices> Have data based discussions about claims processing> Track the Key Steps Required for Accuracy> Who is skipping them?> Who is doing them out of order?> What is the impact of non-compliance?Enkata Improves Processing Compliance
  10. 10. © Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL© Enkata. All Rights Reserved. CONFIDENTIAL10Visit our Websitewww.enkata.comSee a Demosales@enkata.comEnkata can help you

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