It's said that a human on a bike is the fastest animal in the world.
That's how much the right tool can enhance the speed and durability of its human rider.
With that example in mind, let's look at how Mavera Decision Support System (DSS) can enhance the accuracy and efficiency of personal injury claims handlers.
You may find out that it's time for your team to get new bikes.
Automatic review and assignment
First, a claims unit must review the claims, sort them, and assign them for further investigation. It is a time-consuming task that often becomes a bottleneck in operations.
Integrated with your core system, Mavera DSS can automatically review claims using artificial intelligence. It evaluates what to investigate further and what to accept or decline. It can then assign each claim to a suitable claims handler or send it directly to a medical advisor.
This feature is particularly important in health insurance, where the number of caregiver requests can be overwhelming to review.
Faster claims overview
Claims handlers often spend more than half of their working hours reading through medical records.
Some claims can include over 500 pages of medical records that the claims handlers (and medical advisors) must read to understand the injury.
That takes time, and it's easy to see how mistakes might happen.
Mavera DSS can help reduce this time by using deep learning algorithms and optical character recognition (OCR) to quickly and semantically extract data from medical documents and present it in a clear and structured overview.
It helps the claims handlers review cases up to three times faster and reduces the risk of mistakes.
The augmented claims view includes the following:
- Highlighted critical information
- Structured timeline of events
- Visual illustration of where on the body the injury has occurred.
- All documents are sorted and categorized with hyperlinks to specific sections.
Streamlining the process for medical assessments
No one knows it all. Collaboration between claims handlers and medical advisors is essential when evaluating personal injury claims.
Unfortunately, finding and communicating with the right medical advisor can be one of the most time-consuming aspects of claims handling. This can be a challenge whether the medical advisors are part of the insurance company, individual consultants, or part of a larger network.
Without a customized tool to streamline the process for medical assessments, the manual approach can significantly impact claims handling time, leading to inefficiencies.
- Finding a suitable medical advisor with the right competence often requires a lot of sending cases back and forth to find someone available.
- Cases risk "getting stuck" without an overview of the process and to whom it is assigned.
- Complicated cases that require clarifications or second opinions from multiple medical advisors become very complex.
- There is a risk of security and compliance breaches as sensitive medical information gets sent back and forth.
Mavera DSS solves these challenges and provides a tailored workspace for managing communication with medical advisors.
It has helped some of our customers reduce the time of an average medical assessment from 18 days to 48 hours.
- The system automatically assigns each claim to a suitable medical advisor based on availability and competence. It also estimates when the claims handler should get it back.
- It simplifies communication between claims handlers and medical advisors with chat and file-sharing features
- It supports common workflows such as second opinions and clarification.
- Email notifications and structured inboxes make case management easy, so no cases get stuck.
Mavera Decision Support System (DSS) empowers claims handlers to review and overview claims faster, collaborate with medical advisors more effectively, and improve the overall efficiency and accuracy of the claims handling process. Leaving more time for value-adding activities where the human touch really matters.
It is a must-have tool for any insurer looking to improve operations and deliver exceptional service.
So back to the question in the beginning – does your claims team need new bikes?