
EXL's AI-Powered Claims as a Service for Absence Claims
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The Survey Summary provides a download of the vendor profile, solution profile and the VendorMatch Discovery survey vendor responses used to power the directory. All responses are provided by the vendor online.
Note that this report is a high level summary of the vendor's credentials and a solution's capabilities designed to assist with solution short-listing. The RFX report is the more comprehensive Request For Information report designed to support evaluation and selection, this will only show where the vendor has completed the "RFX" RFI.
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To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information on Premium features or contact us.
RFX Report
The RFX report is an XLS download of the Vendors response to the “RFX” Request for Information for this solution.
The RFX is a centralized golden copy of a RFI authored by our analysts based on their expertise in running real-life system evaluation and selection projects and completed by the vendor online.
Note to protect vendor that only Financial Institutions and recognized Advisor can subscribe to this feature.
In each instance the first time the link is used the user requests permission to access the RFX report and it is the vendor who is required to authorizes access. You will be alerted when the vendor has reviewed your request and granted permission.
HOW TO SUBSCRIBE
Please click here for more information on Premium features or contact us.
To learn more about subscribing to our service options, please contact us here
This feature is upgradeable
For End Users
You can activate this feature and other links for ALL VENDORS with a VendorMatch Premium subscription. Additionally you can gain access to an increased depth of data, summary reports, RFX reports (detailed completed RFIs - available to financial institutions only) and comparison grids. Please click here for more information.
For Vendors
Vendors can activate their links and gain access to analytics by upgrading to VendorMatch PRO. Please click here for more information.
Speak with an analyst
Financial institutions and their advisors can subscribe to our Analyst Access* service. Effectively phone or (email) a friend you can have on tap advice and support provided by our analysts on this vendor, solution or solution category.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information.
or contact us to discuss a subscription.
Subject to reasonable use.
Survey Summary
The Survey Summary provides a download of the vendor profile, solution profile and the VendorMatch Discovery survey vendor responses used to power the directory. All responses are provided by the vendor online.
Note that this report is a high level summary of the vendor's credentials and a solution's capabilities designed to assist with solution short-listing. The RFX report is the more comprehensive Request For Information report designed to support evaluation and selection, this will only show where the vendor has completed the "RFX" RFI.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information on Premium features or contact us.
RFX Report
The RFX report is an XLS download of the Vendors response to the “RFX” Request for Information for this solution.
The RFX is a centralized golden copy of a RFI authored by our analysts based on their expertise in running real-life system evaluation and selection projects and completed by the vendor online.
Note to protect vendor that only Financial Institutions and recognized Advisor can subscribe to this feature.
In each instance the first time the link is used the user requests permission to access the RFX report and it is the vendor who is required to authorizes access. You will be alerted when the vendor has reviewed your request and granted permission.
HOW TO SUBSCRIBE
Please click here for more information on Premium features or contact us.
To learn more about subscribing to our service options, please contact us here
This feature is upgradeable
For End Users
You can activate this feature and other links for ALL VENDORS with a VendorMatch Premium subscription. Additionally you can gain access to an increased depth of data, summary reports, RFX reports (detailed completed RFIs - available to financial institutions only) and comparison grids. Please click here for more information.
For Vendors
Vendors can activate their links and gain access to analytics by upgrading to VendorMatch PRO. Please click here for more information.
Speak with an analyst
Financial institutions and their advisors can subscribe to our Analyst Access* service. Effectively phone or (email) a friend you can have on tap advice and support provided by our analysts on this vendor, solution or solution category.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information.
or contact us to discuss a subscription.
Subject to reasonable use.
Survey Summary
The Survey Summary provides a download of the vendor profile, solution profile and the VendorMatch Discovery survey vendor responses used to power the directory. All responses are provided by the vendor online.
Note that this report is a high level summary of the vendor's credentials and a solution's capabilities designed to assist with solution short-listing. The RFX report is the more comprehensive Request For Information report designed to support evaluation and selection, this will only show where the vendor has completed the "RFX" RFI.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information on Premium features or contact us.
RFX Report
The RFX report is an XLS download of the Vendors response to the “RFX” Request for Information for this solution.
The RFX is a centralized golden copy of a RFI authored by our analysts based on their expertise in running real-life system evaluation and selection projects and completed by the vendor online.
Note to protect vendor that only Financial Institutions and recognized Advisor can subscribe to this feature.
In each instance the first time the link is used the user requests permission to access the RFX report and it is the vendor who is required to authorizes access. You will be alerted when the vendor has reviewed your request and granted permission.
HOW TO SUBSCRIBE
Please click here for more information on Premium features or contact us.
To learn more about subscribing to our service options, please contact us here
This feature is upgradeable
For End Users
You can activate this feature and other links for ALL VENDORS with a VendorMatch Premium subscription. Additionally you can gain access to an increased depth of data, summary reports, RFX reports (detailed completed RFIs - available to financial institutions only) and comparison grids. Please click here for more information.
For Vendors
Vendors can activate their links and gain access to analytics by upgrading to VendorMatch PRO. Please click here for more information.
Speak with an analyst
Financial institutions and their advisors can subscribe to our Analyst Access* service. Effectively phone or (email) a friend you can have on tap advice and support provided by our analysts on this vendor, solution or solution category.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information.
or contact us to discuss a subscription.
Subject to reasonable use.
Survey Summary
The Survey Summary provides a download of the vendor profile, solution profile and the VendorMatch Discovery survey vendor responses used to power the directory. All responses are provided by the vendor online.
Note that this report is a high level summary of the vendor's credentials and a solution's capabilities designed to assist with solution short-listing. The RFX report is the more comprehensive Request For Information report designed to support evaluation and selection, this will only show where the vendor has completed the "RFX" RFI.
HOW TO SUBSCRIBE
To protect vendor data only financial institutions and recognized advisors can subscribe to VendorMatch Premium. Please click here for more information on Premium features or contact us.
RFX Report
The RFX report is an XLS download of the Vendors response to the “RFX” Request for Information for this solution.
The RFX is a centralized golden copy of a RFI authored by our analysts based on their expertise in running real-life system evaluation and selection projects and completed by the vendor online.
Note to protect vendor that only Financial Institutions and recognized Advisor can subscribe to this feature.
In each instance the first time the link is used the user requests permission to access the RFX report and it is the vendor who is required to authorizes access. You will be alerted when the vendor has reviewed your request and granted permission.
HOW TO SUBSCRIBE
Please click here for more information on Premium features or contact us.
To learn more about subscribing to our service options, please contact us here
Overview
The Challenge: Group and Voluntary Benefits Carriers dedicate significant human resources to the administration of low margin/ high volume short term disability and leave claims, i.e. Absence Management Services:
- A complex maze of federal, state and municipal regulations coupled with corporate paid leave policies have made absence claims servicing labor intensive
- Additionally, claims processing is highly disjointed, it needs information from multiple parties including the Employer, Employee and Physician
- Highly manual and disjointed processes have produced a poor customer experience for the claimant (employee)
EXL Solution: Claimants (employees) expect their claims journey to be effortless, they want to stay informed and most importantly they want to know quickly if their claim was approved. Claimants expect:
- Easy claims submission at a time and place of their choice
- Short wait times for claims decision
- A single point of contact for disability and absence claims
- 24x7 live access
While the EXL service is focused on improving the claimant (employee experience), EXL can help insurance carriers reduce 40-50% OPEX in the immediate to medium term. EXL brings together their leading Employee Benefits talent and best of breed platforms further augmented by automation to deliver highest value at the lowest risk to carriers. Their flexible deal structure offers committed productivity gains, variable pricing models and gain sharing for advanced analytics transformation.
Key Features
EXL’s Claims Payment as a Service offering helps clients deploy new operating models that significantly reduce OPEX while improving claimant experience. The offering addresses the key components of the operating model i.e. people, process, technology and metrics.
People:
- In the immediate-term, drive value by sourcing all roles other than customer facing roles
- Rebadge customer facing and select SME roles
- Revisit multiple roles within claims function e.g. telephonic claim intake by nurses for a differentiated claimant experience
- Align claim teams by book of business
- Staff for customer service, low complexity back office and high complexity claim adjudication and clinician skills
- Additionally, deploy employment law counsels to support American with Disabilities Act claims and compliance with new leave legislations e.g. First Families Coronavirus Response Act
Process:
- Maintain a single point of contact for the claimant for disability and absence claims – end to end claim ownership.
Intake and Eligibility:
- Deploy self-service automation EXL’s Intelligent Virtual Assistant to make claims intake low touch/ effortless experience
- Intake telephonic claims through nurses
- Institute an AI-powered automation for fast/ rapid claims, e.g. simple maternity
- Automate eligibility decisions for all claims through a combination of employer file feeds and validation of claim, policy coverage, employer special handling data
Core case handling:
- Automate claims review processes to support experienced claim specialists
- Data and analytics driven next best recommendation from analysis of:
- reason for leave
- ICD 9/10 codes
- last working day
- leave duration
- attending physician statement
- employer file feed
- coverage information, and
- special handling instructions
Initial Decision:
- Automate fast/ rapid and routine claims e.g. simple surgeries
- Data and analytics driven claims duration determination for most frequent claim reasons
- Deploy experienced claims specialists supported by clinical staff for complex claim
Ongoing Claims Management:
- Continue the claims specialist to maintain single point of contact
- Leverage data to uncover claims propensity to transition from short term to long term disability
- Refocus efforts to proactively manage complex, improve return to work date
Technology:
- EXL is technology platform agnostic and has developed a suite of digital assets for automating the claim process. Additionally, they can bring partners for best of breed technology platforms.
- EXL’s Intelligent Virtual Billing Assistant – NLP/ AI driven self-service automation for claims intake
- EXL’s Intelligent Content Extraction algorithm – NLP/ AI smart content extraction from unstructured documents to review and auto adjudicate fast/ rapid and routine claims
- EXL’s Claims Duration analytics – data and analytics models predicting accurately claims duration
- EXL’s Return to Work analytics - data and analytics models to uncover claims ripe for clinical intervention for improving return to work dates
Key Benefits
- Improved customer experience
- Customized journeys by Claimant personas
- Single point of contact for the Claimant
- Shortened customer wait time
- Proactive outreach
- Low touch/ straight through processing leveraging EXL’s digital assets
- Maintain and continuously improve key metrics
- Eligibility Notice sent within 24 hours
- Claims adjudicated within 3 business days
- Improved CSAT scores
- 40% to 50% reduction in operating expense