The Challenge
Elevate Claims Solutions, a technology-driven IA firm, took on the industry wide challenge of streamlining the management of large volumes of claims-related correspondence, including forms, letters, bills, and legal documents. Their Claims Admins were set to overhaul the traditional manual tasks of sorting, matching, and indexing each piece of correspondence with the appropriate new claim file, showcasing their commitment to improving operational efficiency. They found that:
Numerous inbound emails that did not adhere to established subject line conventions, often missing critical claim numbers.
Approximately 30% of all incoming correspondence was missing proper claim numbers, requiring extensive manual intervention.
The manual and repetitive nature of these tasks took time when Claims Admins could be reallocated to higher-value activities.
The Approach
In response to these challenges, Elevate Claims Solutions adopted Planflux to support their Claims Admins in the claims intake workflow. This support included integrations and automations such as:
Examining Outlook emails for relevant data like claim and policy numbers, cross-referencing this against existing databases to ensure accuracy.
Outlining the findings and suggested actions — create, update, or ignore a claim — to the Claims Admins, complete with explanations in natural language for clarity.
Streamlined UI, enabling Claims Admins to quickly verify data sources and AI reasoning, ensuring efficient decision-making with minimal human intervention.
Sending approved claims to the FileTrac Claims Management System (CMS) via an API, significantly speeding up the processing workflow.
The Results
The deployment of Planflux led to impressive enhancements in efficiency and accuracy at Elevate Claims Solutions:
A 70% reduction in the time required to enter claims into their FileTrac CMS, markedly accelerating the claims intake process.
The reallocation of thousands of FTE hours to more critical and engaging work, boosting staff productivity and job satisfaction.
The maintenance of a hyper-optimized validation process that achieves 100% end result accuracy and compliance.
A consistent delivery of over 95% accuracy in data extraction, thereby reducing mistakes and increasing dependability in claims processing.
By leveraging Planflux’s advanced document processing and workflow automation capabilities, Elevate Claims Solutions not only streamlined their operations but also significantly improved their effectiveness in managing claims.
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