The Challenge
The third-party administrator (TPA) faced significant challenges due to the seasonal nature of catastrophes, such as hurricanes, which drive their claims processing operations. With a 50-person team, including desk administrators responsible for processing and intaking First Notice of Loss (FNOLs) and claims, the information is then uploaded into their claims management system where a manager assigns tasks to field adjusters. The primary difficulty lies in managing the fluctuating workload caused by these seasonal catastrophes. Hiring full-time employees is impractical because they would not be consistently occupied throughout the year. Attempting to fulfill peak demands by contracting non-fulltime employees (1099s) has also proven unreliable, as it is challenging to secure enough contracted personnel at short notice during a catastrophe.
Specific challenges in their day-to-day tasks included:
Receiving claims assignments via email, often in varying formats.
Manually keying in the claims information into their claims management system.
Limited ability to scale intake operations quickly during high-demand periods.
Inefficiencies due to desk administrators juggling intake tasks with other responsibilities.
Loss of potential revenue due to unprocessed claims during peak periods.
The company recognized the need for a solution to streamline their claims intake process and handle the fluctuating demand more effectively. However, investing in an internal tool was not feasible due to the size of their business and their lack of technological expertise. Developing such a solution would divert resources from their core operations and ultimately be cost-prohibitive. Therefore, they sought an external solution that could provide the necessary scalability and efficiency without the need for significant internal investment.
The Approach
In response to the challenges faced by the third-party administrator (TPA) during catastrophic events, the company adopted Planflux to enhance their claims intake process. This solution provided key integrations and automations to meet their needs:
Planflux automatically scans all Outlook inboxes to identify and isolate claims-related emails, including attachments from carriers, ensuring no crucial information is overlooked.
The system extracts relevant details from each claim, such as policy numbers, loss descriptions, and contact information, directly from the identified emails and attachments.
Planflux offers a user-friendly interface that allows desk administrators to quickly verify the extracted data and AI reasoning, facilitating efficient decision-making with minimal human intervention.
Approved claims are automatically uploaded to the claims management system via an API, significantly speeding up the intake workflow and reducing manual data entry errors.
By implementing Planflux, the TPA was able to effectively manage the fluctuating claims intake during peak periods, ensuring scalability and operational efficiency without the need for significant internal technological investments.
The Results
The deployment of Planflux led to significant improvements in efficiency and accuracy for the third-party administrator (TPA).
Achieved a 90% reduction in the time required to process and enter claims into their claims management system, significantly accelerating the claims intake workflow.
Reallocated tens of thousands of FTE hours to more critical and engaging tasks, enhancing staff productivity and job satisfaction.
Maintained a hyper-optimized validation process that ensures 100% accuracy and compliance in the final results.
Consistently delivered over 95% accuracy in data extraction, reducing errors and increasing reliability in the claims processing workflow.
By leveraging Planflux’s advanced document processing and workflow automation capabilities, the TPA was able to automatically scale and handle any load during catastrophes. This ensured that their existing staff was sufficient to manage and intake all claims, regardless of volume. Additionally, the pricing and usage of Planflux scaled appropriately, up and down, providing a cost-effective solution that matched their operational needs.
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