Insurance companies: Claim processing
Many organizations operate in complex spaces where a single customer journey requires the involvement of multiple departments. The insurance industry is a prime example. The claims review journey involves several participants, including insurance agents, adjusters, underwriters, and accountants. Information needs to pass promptly between them for the journey to progress smoothly and the employees to be able to collaborate effectively. Zoho CommandCenter is ideal in this scenario to help ensure that the journey occurs as it should, and every employee has the information they require from the previous stage to perform their job.
In this scenario, the claim journey begins when the claimant submits a claim, either manually or through an online form. An insurance agent checks the form and verifies the claimant's basic information and updates the claim amount in their internal system. The claim adjuster investigates the case, interviews the necessary parties, and prepares a report. Any additional documents required from the claimant's end are collected before the journey can continue. The adjuster can easily select a list of necessary documents and send an automated email to the claimant. The final review varies based on the amount the company is liable to pay. If it is less than $1500, a basic document verification occurs. If the amount exceeds $1500 or fraud is suspected, a background check is launched on the claimant to identify any history or risk of insurance fraud. If fraudulent activity is confirmed, a legal case is filed. If all checks are completed successfully, the insurance underwriter reviews all the information collected on the case from the start, and approves or rejects the claim. Finally, the claimant receives a check or an automated rejection letter depending on whether the claim is approved or rejected.
Identify review journey delays
With CommandCenter, it is easy to track the current status of any claim, as well as analyzing the overall journey and identifying any delays or areas for improvement. For instance, delays in the document collection stage could indicate the need for easier collection from the claimant. It is also possible to look into the statistics for claims below and above $1500 and compare their efficiency at various stages.
What happens behind the scenes?
CommandCenter works with multiple platforms in the course of this journey. This includes document management software which is used to collect the documents needed for verification and accounting software to issue claim amounts once approved. CommandCenter also integrates with the company's website to identify when a new claim request is submitted and email systems to track communications between all the departments involved in this journey.
Some of the integrations are not available out-of-the-box, and need to be built using Zoho's Open API. If you need help integrating CommandCenter with any of the platforms you use, contact us at support@zohocrm.com.