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Insurance

How a health insurer cut claim processing time in half without a single surveyor visit

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OVERVIEW

Closing the Gap Between a Claim Filed and a Claim Settled

A mid-size health insurance provider managing individual and group health plans was running its claims and servicing operations through a traditional model: inbound calls, email submissions, and field surveyors dispatched for physical inspection of small claims. The cost and time involved in the surveyor model was disproportionate to the claim value being assessed, and customers were waiting days for resolutions that could have been handled remotely.

The carrier also had a multilingual policyholder base across diverse geographies. Their support infrastructure had no capability to engage customers beyond a single primary language, creating a meaningful servicing gap for a significant portion of their base.

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CHALLENGES

A Claims Model Built for a Different Era

The carrier's claims and servicing problems were connected. Every physical touchpoint that could have been remote, and every interaction that could have been automated, was still being handled manually. The cumulative effect was a process that was slow for the customer and expensive for the carrier.

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Small and medium claims required a field surveyor visit regardless of complexity, making resolution slow and costly across most claim types.

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Support operated in one language during business hours, leaving a large share of policyholders without an effective service channel.

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Document submission required a branch visit or email process that most customers did not complete.

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No secure remote identification process existed, limiting what could be resolved without physical presence.