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Claims processing

Streamline claims and improve customer satisfaction

Improving efficiency in claims processing sb resource center en

Improving efficiency in claims processing

Most insurance companies are unable to manage tasks or distribute work to the right resources in a timely and cost-effective manner. These inefficiencies not only keep you from achieving your organizational goals, they also impact customer satisfaction.

Genesys, the leader in omnichannel customer experience and contact center solutions, has helped a number of insurance agencies improve both efficiency and customer satisfaction with the Genesys Omnichannel Engagement platform.

Optimize internal processes

In the typical organization, offline work items are unmanaged, and the time required to address them isn’t tracked. This makes it nearly impossible to optimize the productivity of your staff and can result in frequent backlogs. Work items are kept in a multitude of applications or systems, and productivity drops when your employees are searching for the next task to tackle or worse—”cherry picking” items they enjoy instead of handling the most important ones. In fact, Genesys research reveals that back-office employees spend 28% of their time performing unproductive tasks.

The Genesys Enterprise Workload Management solution helps you:

  • Prioritize tasks based on value and staffing.
  • Meet service delivery levels.
  • Analyze processes for efficiency and insight.

Prioritize tasks based on value and staffing

Aligning claims-processing priorities with your organizational objectives is the key to efficiency. For example:

  • Which claims should have the highest priority?
  • Which tasks are in jeopardy of missing due dates?
  • Which appeals processes might need specialized resources?

Without a careful, rules-driven approach to task assignment, inefficiencies are virtually guaranteed. And without visibility into which claim is with which agent—and when they viewed the claim—it’s virtually impossible to monitor the effectiveness, efficiency and skills of your staff.

The Genesys Enterprise Workload Management solution can match each task type in the overall claims process with the right priority and person to handle it. Based on a combination of skill levels, task complexity and SLAs, our solution flexibly determines whether a staff member can select a task or they are proactively assigned to them based on availability—or some combination of the two.

Ensure service delivery levels

The Genesys Enterprise Workload Management solution automates processes to ensure that you meet service-level, contractual and performance objectives. For example, if your goal for initial processing time is 45 days, any unprocessed claims approaching that deadline could automatically be prioritized at the top of the task list.

Analyze processes for efficiency and insight

By seeing and understanding internal processes as they happen, you can identify opportunities for savings. Real-time and historical reporting within Genesys allow you to track, analyze and continually optimize claims processing and gain visibility into trends in your membership that you otherwise wouldn’t have seen.

Improve the pre-claims experience

Improving self-service and assisted-service offerings can streamline claims management— even before a claim is filed. Filling out insurance forms requires specialized knowledge; those who are new to the process frequently make mistakes.

You can help your providers and customers by:

  • Offering in-context web chat and the ability to co-browse with policyholders, beneficiaries, providers or suppliers to complete online forms faster and with fewer errors
  • Delivering personalized status updates via a sophisticated IVR system, which can reduce call volume and allow your agents to handle more complex issues
  • Providing the ability to schedule a callback at a time convenient for both parties—with choices provided by phone, web or mobile app—which increases the likelihood of issue resolution
  • Ensuring that all of the relevant information is preserved throughout the customer interaction, regardless of the channel, so the responding agent automatically receives the full context—a key to omnichannel engagement
  • Proactively notifying providers or beneficiaries when errors or omissions are spotted—Twitter, Facebook and mobile messages to beneficiaries or policyholders, can include a link to a self-service resource or a web page that contains instructions or updates
  • Communicating with your customers using the channels of their choice

When optimization processes are in place, tasks are streamlined, employees are empowered and customers have consistent experiences across all channels.

Benefits of omnichannel engagement

Genesys gives you:

  • A single, comprehensive system of engagement that supports all voice and digital channels
  • 360-degree visibility and operational control for all customer engagements
  • Integrated omnichannel workforce optimization
  • Open and highly scalable platform
  • Consistent, global operational control
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