DecisionsFirst™ Insurance Claims Handling

Insurance claims handling is a complex business. Customers want their claims processed quickly and their claims to be approved. Carriers need to manage risk, avoid paying ineligible claims, keep operating costs low, and comply with myriad government regulatory requirements.

To keep processing costs in check and meet all of their compliance requirements, many insurance companies have a goal to increase the percentage of their claims that can be processed and adjudicated with no human decision-making involved. In other words, increasing their rate of straight through processing.

Decision Management Solutions has developed a unique solution to do just that. It focuses on the claims handling decisions first (hence its name). We partner with an insurance carrier to examine their current claims management approach with a persistent focus on the decisions themselves. A discovery session identifies areas of opportunity for streamlining and automating the decisioning approach.

From here a decision model is built and iterated and the software solution is developed, tested and implemented based on each client’s unique technology infrastructure, or our cloud-based delivery architecture. Clients also receive a dashboard on which they can simulate changes to their rules or policies prior to making those changes live and can continually review and update their approach.

As a result, clients see an increase in their straight-through claims processing rates and claims get paid more quickly. Even for claims that need to be reviewed by an adjuster, the DecisionsFirst Insurance Claims Management solution expedites the process, improving speed and reducing operating costs. Finally, this decision automation improves regulatory compliance by ensuring consistency in claims handling.