EXL’S P&C Insurance Claim Payments as a Service Offering

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Overview

The Challenge: Property and casualty insurers’ claim functions typically have multiple bill intake channels, several review and payment workflows, different supplier contract terms, high adjuster touch, all running on legacy systems, often without a workflow tool. The customer experience becomes sub-optimal because the bill often enters a black box as soon as it is sent to the insurer. It is extremely challenging to track and reconcile adjustments and payments. Additionally, they operate at a high operating expense (OPEX) while providing limited insights from data to reduce claim leakages in form of penalties & interest, usage of a high cost suppler or over/under billing.

The EXL solution: EXL provides an end-to-end solution from bill indexing to bill payment for medical, non-medical, legal and indemnity payments integrated with supplier and spend analytics. Customers (both claimants and providers) expect and will experience a simple, timely and accurate billing experience.

While the service is focused on improving the customer (claimants and providers) experience, EXL can help insurance carriers reduce 30-40% OPEX and 20%-25% claim leakage in the immediate to medium term. EXL brings together leading claim bill review and payment talent augmented by automation and analytics to deliver the highest value at the lowest risk to carriers. A flexible deal structure offers committed productivity gains, variable pricing models, committed outcomes, lower cost per claim and gain sharing for advanced analytics and digital transformation.

The expectation from an optimized bill payment function is to:

  1. Provide a single point of contact, more education and proactive outreach when it matters
  2. Keep adjustment communication simple and easy to understand manner
  3. Ensure payments terms are applied correctly and on a timely basis
  4. Required controls and checks are established to avoid leakages
  5. Provide data insights to upstream process that enables optimized supplier selection

EXL’s Experience & Capabilities

  • Experience supporting claim payments for ten leading Property & Casualty carriers across the globe
  • Experienced workforce of 300+ resources supporting review and payment for ~3.5M+ bills annually. The team has experience in handling medical, non-medical, and legal and indemnity payments across all product and market segments.
  • EXL has active operations in the following locations
    • Jersey City, NJ, US - for all mailroom and scanning related services
    • Dallas / Fort Worth area - for all U.S. onshore related services
    • Bogota, Colombia - for U.S. nearshore related services
    • Sofia, Bulgaria, Olomouc, Czech Republic and Cluj, Romania for all European language and European nearshore related services
    • Bangalore, Noida, Pune, Gurgaon, Kochi for all offshore related services (including LATAM and European languages)
    • Manila, Philippines for U.S. voice and clinical services

Key Features

Eliminate the need for multiple handoffs through role rationalization and seamless workflow across the bill payment chain – bill intake and indexing, bill review, bill payment reconciliation and handling customer/provider inquiry

Bill Intake

  • Ability to ingest bills through any channel – postal mail, email, fax and supplier portals etc.
  • US based scanning and indexing facility to accept postal mail
  • Digital utility to convert invoices into structure dataset (Bill receive date, due date, supplier information, claim#, amount etc.) that gets ingested in the bill workflow and automatically flows through the next logical step
  • Automated notification for the bill sender advising on expected payment release date

Bill Review

  • Integrated partner network and platform to allow for medical bill adjudication
  • Experienced bill review staff with expertise in medical and non-medical bill review functions
  • Established legal services support solution with a team to support comprehensive audit of legal bills
  • Weekly wage calculation using EXL’s Wage Calculation tool, aligned with state rules and guidelines
  • Ability to connect with claim handlers, if required (through multiple channels)
  • Data insights on supplier trend, provider network, duplicate bills, etc.

Bill Payment

  • Automated prioritization basis payment due date of bills to avoid any late fees, penalties and interest
  • Digital payment posting solution for posting payments on insurer’s claim payment system and attaching invoice to the system of records
  • Automated adjustment of amount for early payment discount, deductibles, etc.

Reconciliation, Customer/Provider Inquiry

  • Chat bot for online enquiry of bill status
  • Dedicated customer service team to respond to bill enquiry, reconsiderations requests etc.
  • Automated monthly reconciliation of incoming bills vs. paid

Technology

While EXL is technology platform agnostic, the company has developed a suite of digital assets for automating the billing process. Additionally, they can bring partners for best of breed technology platforms.

  • EXL’s Digital Extraction and Indexing solution – Digital extraction of key invoice value for automated triage and indexing
  • EXL’s Multi-Channel Smart Workflow Management (MSWM) tool for effective inventory management
  • EXL’s Spend Analytics solution for benchmark analysis, supplier spend comparison, provider and counsel network optimization
  • EXL’s Bill Payment Bot – Smart Robotics solution for automated payment code identification, duplicity check and payment posting
  • EXL’s Virtual Billing Assistant –Chat bot for online enquiry of bill status
  • EXL’s Wage Calculator – Solution that ingests W9 forms and returns weekly wage basis state specific guidelines

Key Benefits

  • Improved customer (claimant and provider) experience
    • Single point of contact through centralized bill enquiry team
    • Proactive outreach with simple and clear communication
  • 30% to 40% reduction in OPEX
    • Global talent pool
    • Low touch/ straight through processing leveraging our digital assets
  • 20%-25% reduction in claim leakage in the immediate to medium term
  • Access to EXL's partner network

Product/Service details

SOLUTION OR SERVICE TYPE