An open laptop sitting on a desk with open and closed file cabinet drawers covering its screen.

Wednesday, September 09, 2020

Innovating for Next-Level Stop Loss Claims Processing

By Kristen Baker

You can probably imagine that working with more than 100 third party administrators (TPAs) means that HM Insurance Group (HM) receives tens of thousands of claim detail files every year. It’s a lot of data to manage. Files come into a secure, designated Stop Loss claims email box or via an FTP site. They are then saved to a corporate drive so our Claims team can format the TPAs’ Excel files into a format acceptable for loading into our claims system. The entire process takes a lot of manual work.

Improving Capabilities

So, we thought it was time to determine if technology could assist us with claim intake. To begin, we worked with our Information Technology (IT) department to brainstorm solutions. Keeping in mind that we make it our goal to pay claims as quickly and accurately as possible for our clients, we decided to on-board the assistance of our Rapid Process Automation (RPA) team to help power the endeavor.

Bringing in BOTs

Helping to ensure our new approach would work well into the future, the RPA team incorporated BOTs, which are, technically speaking, “internet robots” that are used primarily for scanning and interacting with content in a web-based environment. Our claims BOTs automatically save emails from TPAs, along with their individual attachments (claim files), onto our corporate drive. In addition, they also create a list of emails saved, which we can use for our daily assignment process. This saves a significant amount of time for claim intake.

Creating a Lake

The next phase of our endeavor takes on the challenge of transitioning all files to our standard format that come in to us from TPAs using their own format, something that also historically has taken a considerable amount of time. We are in the infancy stages of creating a data lake where the TPAs’ files will go. From this data lake, each file will flow into our standard file format. We are working with IT to create a map for this process. Once our data lake is complete, it is expected that our claim intake capabilities will be more streamlined and efficient. 

Enhancing Analysis

The data lake also will provide improved analysis tools. All departments within HM that need to review claims information will have access to real-time data to assist with decision-making. When data is easily available, it helps to ensure that our clients are receiving the best customer service possible from HM, as we can quickly and easily access group details and assess the trends that influence outcomes. This data helps to ensure reliable RFPs/proposals from our Underwriting team as well as better than industry standard claims processing turn-around times.

Making an Outstanding Transformation

I think we can all agree that 2020 has not been an easy year. But at HM, we’ve focused our energy on a transformation. Our Claims area is using technology to empower smart practices that reduce manual intervention and create efficiencies for our team. This increases the effectiveness of our ability to pay claims, which is at the core of our commitment to our customers. This investment takes our capabilities to the next level – and sets us apart.

For more information on HM Insurance Group’s Stop Loss claims administration capabilities, check out our Operational Performance Results (PDF).

Why HM

A strong, experienced carrier, HM responds to market changes and works with clients to ensure their coverage needs are met through expert risk assessment and exceptional delivery of benefits.