Alberta Motor Association (AMA)
Paper Insurance Claims were causing process bottlenecks in the organization. Claims processing was regionalized to 3 main centers (Calgary, Red Deer, Edmonton) and the paper needed to be shipped between centers if workload wasn’t balanced. For example, if Edmonton had a hail storm disaster and thousands of claims were filed by homeowners the claim information would be filed and boxed and then needed to be shipped to Red Deer and Calgary to assist in processing the claims in a timely manner.
A further drawback of paper claims was the need to key in each data field from the Claim system (Guidewire). This was painful for claims processors as it was a repetitive lookup and data keying task. i.e. ( Lookup the same Policyholder information on each claim).
An additional feature that the management desired was the ability to have oversight into each claim their team was processing and the ability to re-assign the workflow task if someone was out sick or working on a claim that took much longer, as each claim doesn’t take the same amount of effort to complete
The solution to the workload distribution problem was to establish a Document scanning team at the Edmonton office. Claims could be emailed digitally or mailed to this office for scanning. The document scanning team members would scan & file the claim appropriately in the ECM System (OpenText) which would then a workflow would start distributing the claim task accordingly.
To resolve the data entry issue an integration needed to be established between the Claim System (Guidewire), the Scanning Solution (Kofax) and the DMS (OpenText Content Server). Cadence Solutions implemented this solution vision via an Agile methodology. Within a few months the systems were integrated, tested by users and deployed into a production state. Below is a high-level data flow of the final solution.
Figure 1 - Dataflow for Paperless Insurance Claims
To ensure management had the proper insight a custom workflow portal was developed for AMA. This included the ability to reassign tasks, change permissions and adjustors at a claim level. This made the solution very flexible and reduced maintenance.
All three benefits were realized within 4 months. With the Data Entry and Digitization of claims harmonized the ability to distribute load between centers enabled proper staffing in each center with less peaks and valleys that used to frequently require temporary staff or contractors.