Claims Processing Automation

Claims Processing Automation

Manage, Process, and Optimize your Claims at Ease

From personal and commercial insurance line underwriting and onboarding to policyholder services and claims processing, RPA is already making drastic changes in the way that insurers operate, improving customer service and reducing cycle times while reducing overhead.

In insurance, RPA is defined as implementing software robots that can be custom configured for each computer, without the use of code. These software robots help their real-life knowledge-workers with the monotonous and repetitive chores in insurance work, such as data entry.

RPA effectively brings to insurance operations an AI-driven digital workforce, i.e., robotic assistants that are able to take over employees’ basic computer commands, handling a variety of “low-value-add” tasks that currently drain these workers’ time, energy, and morale.

Claims Processing Automation

RPA in insurance claims processing redefines the workflow to integrate different claim processing information from multiple sources, thus offering a myriad of benefits. Automating manually intensive processes like error tracing, claim verification, and extraction of data allows insurers to optimize cost and manual labor. Robotic process automation is a vital cog in reconciliation as it allows companies to upload an electronic version of bank statements and reconcile it to the system using ‘matching’ rules incorporated into the system.

From The Company

We at Lab RPA provide you a complete CLAIMS PROCESSING process Automator, the best automation solution which includes a step by step solution from making the business logic to orchestrate the software robots which possess the key features:

  • Streamlining the Entire Process
  • Speeding Up Claims Processing
  • Delivering Higher Quality , Higher Compliance and Accuracy of the claims Claims accountability
  • 24/7 availability
A full-fledged operational automated framework to manage all of your CLAIMS  PROCESSING processes and operations.

Key Challenges And Characteristics

The concept comes with its own automation challenges though. These are natural challenges, maybe every automation system cannot overcome them. Some of the most common eCommerce automation challenges are multiple integrations, dynamic product information, and frequent changes to the configuration. Multiple integrations refer to the various third-party system integrations that work on both ends of the system. Integrating all these integrations and having them work in sync with the newly induced automation process could be quite a challenge, which makes automation difficult.

There're some Key Concerns

Let's discuss them briefly!

Lack of governance and cohesiveness

Longer processing time

Nuances in the extraction of data and claim verification

Risk of manual intervention during reconciliation

Implementation Time & Cost

Disparate mediums: The disparate medium through which information is processed and collected (like images, emails, papers) creates a lack of accountability and ownership.

Legacy systems: Lack of integration of legacy systems with newer solutions hamper productivity.

Data retrieval: Data retrieval poses a huge challenge when multiple software, processes, systems, and applications are used.

Regulation and compliance: Change in laws and regulation can severely impact the claims processing, posing a serious challenge for companies to remain compliant when operating in different states and countries.

Organizational Challenge

• Lack of time commitment from local team
• Lack of leadership buy-in
• Lack of IT support
• Lack of support from Analytics/Data function
• Lack of support from HR
• Unclear responsibilities
• Company lacking a clear RPA strategy

Process Challenge

• Choosing a process that changes frequently.
• Choosing a process with insignificant business impact.
• Choosing a process where errors are disproportionately costly.
• Choosing a process that involves higher-level cognitive tasks.
• Choosing a process where better custom solutions exist.

Implementation Challenge

• Pursuing in-house RPA development with in-house teams that do not have enough capacity

Technical Challenge

• Choosing a solution that requires intensive programming.
• Not relying on RPA marketplaces and other readily available tools.
• Choosing a solution that did not demonstrate scalability.

Post-Implementation Challenge

• Not building for scalability
• Not taking maintenance needs into account
• Not securing RPA privileged credentials

The Key Characterstics

Let's discuss them briefly!

Open, login, and toggle between different applications and systems.

Copy and paste data from spreadsheets to core systems.

Move data from core systems to spreadsheets.

Move information from Core System A to Core System B. 

Pull data from invoices into a core system.

Open an email and move its data into a core system.

Scrape information from the internet and websites.

And so on....


Faster Claims Processing

Claims processing requires employees to gather information from various documents and copy/move that information into various systems. It’s a time-consuming process, which delays the timely response that customers desire when they file a claim. RPA can move large amounts of claims data with one mouse click.

Easier Policy Cancellation
The process of cancelling policies is time-consuming due to having to interact with email, a policy administration system, a CRM, Excel, and PDFs. RPA can toggle through all of these interactions at the same time and eliminate the need to move data through all of them manually.
Simplified New Business On-Boarding
Sometimes companies grow faster than they can manage. Robots can abet growth with minimal growing pains: manual inter-departmental data movement from new clients being on-boarded can be reduced by at least 50% – within weeks.
Easy Transition

Working at the familiar desktop level, robots are easy for employees to understand and to use. They can be installed quickly (unlike traditional IT projects), and work with existing technology.

Increased Customer Satisfaction
Prospective clients instantly receive an email with a letter of authority for them to sign and return to get the claims process started straight away.
Data Validation

The robots check the digital signature on the letters of authority is validated against the original inquiry.

Staff Satisfaction
Staff have been freed up to work on value added claims handling activity. The repetitive nature of the processing tasks meant it was a tedious job to do. The team are now enjoying completing more interesting and enhanced skills based claims handling tasks, which will ultimately improve our staff retention.
Legacy-systems compatibility and new system implementation friendly
Robots can be configured to use old systems that might be replaced in the next few years, and updated to work with the new ones. Robots are easily reconfigured within days to point to new systems as they get implemented.
Increased Data Accuracy
Using RPA increases the reliability of data. That’s because, unlike humans, robots are unable to key in data incorrectly; nor will their “minds” wander while performing repetitive tasks. But, you must resolve bad data being received on the front end for it to work right.
Standardized Processes
A side effect of using robots is the necessary standardization of processes. In order to start using a robot, a company’s process all need to be standardized, which in turn increases worker efficiency, and then greatly increases the speed at which the robots can do their work as well.

ROI Realization

One of the crucial factors in achieving high ROI is in understanding what can be achieved through RPA and selecting the right processes to automate. Automating a small process with a time-saving of few minutes per process can yield better savings over a year. For instance, RPA driven cost rationalization in horizontal processes such as HR, finance and accounting, procurement, contact center process are much faster than industry-specific processes such as claims processing.

The biggest hurdle in value realization is the complexity of processes. Process complexity can increase with stringent regulatory requirements, geographies, and numbers of exceptions that can potentially stretch development and user-acceptance testing time. While you can expect to reach break-even in six months for simple processes, it may take you as long as two years for complex ones. Cost savings can vary from 10% to 50%, once again determined by the complexity of processes.

Confidential processes where there is a high risk in involving humans merit your scrutiny for robotic process automation as well.

When there is a potential to save $2 trillion in global workforce costs through automating 45% of work activities (according to PwC), no wonder enterprises are drawn to invest in robotic process automation (RPA). RPA is believed to demonstrate value realization faster than many other automation initiatives.

RPA takes just about 25% of the time required for a business process workflow solution and 16% of the time taken for enterprise application integration to demonstrate significant value. One of the immediate perceivable benefits of RPA is cost reduction by employee optimization — freeing them from routine tasks to do jobs that demand high cognitive skills.

Calculating ROI requires a detailed analysis of parameters unique to your organization. Some of the pre-requisites to achieve significant early ROI are:

  • Identifying suitable tasks for automation
  • Carving out appropriate processes
  • Choosing the right systems


A typical ROI realization process takes from 6 to 9 months

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