According to the Association of Coalition against Insurance Fraud estimate, U.S. people lose $80 billion every year to insurance fraud. In addition to this, nearly 78% of American citizens worry about insurance fraud. Needless to say, claim fraud is increasing day by day, and it becomes the primary concern of every claim processing organization.
Every claim processing entity is susceptible to fraud because there are several kinds of online threats that are challenging to detect. Fraud will continue to be a massive drain on the economy of the world. According to the Association of Certified Fraud Examiners report, the total loss caused by fraud is approaching around $4 million, which is a serious alarm. To prevent all these frauds and keep the landscape of the insurance industry safe, every company is seeking digital claim processing solutions to mitigate the chances of claim processing frauds while improving the overall claim operations and turnaround.
What Is Claims Management Software?
Claims Management Software is a beneficial technology because it can record tasks performed by computers or humans and then achieve the same task without any human intervention. With the help of this technology, every insurance business can process claims faster and also identify frauds in different ways. To put it simply, Claims Management Software is designed to reduce human interaction, and glitches in the operation loop. Claims Software mimics human actions to perform tasks fastly, accurately, and efficiently without accelerating the operational cost.
It can easily perform jobs administration, record-keeping, enrollment, customer services, collection of charges/bills, overseeing smooth claim settlement process, communicating with other digital systems, and response triggering. The best part is it ensures accuracy and consistency of outputs, does not break down, and can work for 24*7 without any issue.
General Features of Claim Software
- Ease Of Use For Minimal Training Time
- Simplified Eligibility And Claims Processing
- Advanced Claim Adjudication With Automated Processing
- Instant On-screen Reporting, Web Reporting, Web Dashboards
- Cost-Effectiveness And A Predictable Roi
- Open Architecture Databases For Access By Third Party Applications
- Latest SQL 2016/2017 64 Bit And Ms .Net Architecture
- Scalable To Millions Of Insured Members
- Multi-level Group Security With Logging Of All Events
- Multiple Company, Multiple Database Support
- Integrated Pre-approval And Pre-authorizations
- Rapid And Flexible Benefits Plan Setup
- British And American Date Support
- Real-time Web Access Portal For Insured’s, Providers, And Groups
- Complete HIPAA Compliance And Edi Interfaces
Different ways Online Claim Processing Software help to avoid insurance fraud:
- Minimize Human Interactions: In earlier times, employees deal with claim data and get the opportunity to manipulate the data. But now, with the introduction of digital claim handling, all the processes became automated and eliminated human interaction, which means it has become difficult to fraud in businesses.
- Look Out for Anomalies: It is very challenging for banks or financial institutions’ employees to keep their eyes on fraud because they have to deal with many financial transactions regularly. But with the help of digital claim software, the high-volume transactions can be completed within seconds.
- Implement Compliance: Online claim processing software is beneficial for staying compliant with KYC process steps. Businesses have to collect each customer’s Personally Identifiable Information (PII) for document verification. For a complete audit trail, RPA-based solutions help to update a record of all data collected by employees and customers. By using E-KYC, it became easy for businesses to extract data for KYC customers to accurately handle every claim escape.
- Automate Report Generation: RPA is very helpful because it eliminates the need for manual processes in case of any fraudulent transaction. This technology can generate reports within a few seconds and can save time, resources, and money.
- Automate Temporary Block and Removal: RPA can block accounts that show suspicious behavior and also inform the end-users. This will help to eliminate the high risk of financial crimes.
- Integrate with Machine Learning: To avoid fraud, it is beneficial to integrate RPA with Machine Learning. These technologies can create self-learning models to analyze newer fraud patterns.
In all sense, Claim handling software is just not less than a blessing for the insurance industry to reach new heights.
How Datagenix Can Help You?
To avoid any kind of fraud and empowering your business, you can rely on Datagenix comprehensive claimscape suite that covers everything you need to run a smooth claim processing business. We are here to help you out with our high-end technologies and automation that will help you to operate your business safely.
Final Words
This article will help you to stay and aware of claims insurance frauds that can be done anytime and anywhere. You might have got enough knowledge about employing claim processing software and its many associated benefits and different ways to prevent business fraud.
