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Real-world automation: Ventiv client to use RPA in claims administration

According to Gartner, robotic process automation (RPA) is the fastest-growing segment in enterprise software. RPA holds great potential to reduce costs, increase accuracy, improve compliance, and automate work in a fraction of the time and cost of typical IT software deployments. This blog post covers how one Ventiv client, a financial-services company, plans to deploy Ventiv RPA.

Since becoming a Ventiv Technology customer in 2005, this financial-services company has steadily added capabilities and users to Ventiv Claims (the claims administration system formerly known as iVOS). The company started with 18 users and now has more than 200 users.

As part of its ongoing commitment to improving efficiency, this financial-services customer plans to implement Ventiv RPA to improve claim assignment and document distribution.

RPA—short for robotic process automation—is a proven, effective way of automating manual, repetitive tasks that tend to consume an employee’s time and prevent them from performing the kind of knowledge-based, value-adding work that can’t be automated. With RPA, the Ventiv team trains and deploys bots, sometimes referred to as digital workers, to perform specific tasks, thus freeing up staff for more rewarding work.

It’s important to note that this customer (like most RPA users across the business world) is not using Ventiv RPA to replace employees. Rather, as the company experiences continuing strong growth and a resulting rise in claim volumes, it sees RPA as a means of A.) managing growth without necessarily adding new staff; and B.) relieving staff of the tedious manual tasks they’d really rather not have to do.

Here’s how this financial-services customer is using Ventiv RPA to achieve its efficiency goals:

Claim Assignment

For claim organizations, claim assignment is one of the most attractive uses of RPA. Here’s how it works for this customer:

Throughout the day, a Ventiv RPA digital worker, or bot, scans Ventiv Claims for open claims. When the bot finds an open claim, it captures the type of claim and the insurer that originated the claim.

Then, the bot scans an online spreadsheet and matches the open claim to adjusters who handle A.) that claim type and B.) claims from the insurer named in the open claim. The bot then factors in other criteria in the spreadsheet before making the assignment, including the adjuster’s current workload and whether the adjuster will be in or out of the office. If the customer wishes to add additional criteria to the assignment process, it can easily do so.

To ensure that adjusters don’t exceed their claim load, the bot is programmed to balance out claim assignments using an evenly distributed, “round robin” method.

Before deploying RPA, multiple employees handled the claim-assignment process. As claim volume grew, these staff members found their days increasingly taken up by claim assignment. Now, they have more time to put their claim-adjudication expertise to work.

As for return on investment, without Ventiv RPA, this customer estimates it would have had to hire an additional full-time equivalent (FTE) to handle increasing claim volume. And the news gets even better: As claim volume continues to grow, the Ventiv RPA bot will be able to handle the growing volume with ease, thus preventing the company from having to hire additional staff beyond the additional FTE for which Ventiv RPA has already accounted.

Document Distribution to Third Parties

Over the course of its adjudication, the typical claim generates a large volume of content, including adjuster notes and other documents.

There are many instances when this claim-related content must be reviewed, selected, compiled, and distributed to an authorized third party (attorney, bill-review partner, nurse case manager, medical provider, etc.).

Distributing claim-related content to third parties is a time-consuming task for adjusters. Here’s how Ventiv RPA lightens the load for adjusters:

For this client, adjusters most often share content with third parties from under the “Sticky Notes” and “Document Images” tabs in Ventiv Claims Management Software. Before Ventiv RPA, the adjuster would have to scan content under these tabs, select and download the relevant files, and then email or fax the files.

With Ventiv RPA, the adjuster still has to select the files they want to distribute; however, once those files are selected, the adjuster has only to click a button and a bot takes over: files are downloaded to a secure server, from which the bot then emails or faxes the files to the recipient, based on the preferred method noted in the recipient’s contact record.

Investing in new technology: walking the walk

It’s easy for a company to say it’s committed to making the most of new technologies available to it. It’s not quite as common to find a company like this Ventiv customer that walks the walk by investing in solutions like Ventiv RPA that not only enhance efficiency, but also improve the employee experience. On that score, this financial-services Ventiv client is to be commended.

Read our new report Robotic Process Automation: The power of automation in insurance

Oct 24, 2019


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