top of page

Identify the Ideal Routing Rules for Moving Claims

Writer's picture: Rick TuckerRick Tucker
 

Case Study # 2 from the recently published eBook

Book Summary Image

Our Story of Claims Routing:

Tonya had always been proud of her role as the head of operations

at DentaCare Insurance. The company had grown rapidly, and to

manage costs, they had implemented a system where most dental

claim receipts were routed offshore for processing after being

indexed with a claimant number.

One day, Tonya noticed an alarming trend. Customer complaints

were on the rise, and the claims department seemed to be constantly

scrambling. She decided it was time to take a closer look at

their processes. which she knew would be difficult given complex

workflows, data, and bias that can go undetected.

Tonya brought in a team of process mining experts. As they dug into

the data, a pattern emerged. Certain types of claims were frequently

being sent back to North America for reprocessing. These complex

cases were causing bottlenecks and frustrating both staff and customers.

We’re only successfully processing 60% of claims on the first try,”

Tonya explained to the board. “We need to make a change.” <<Read More>>


How Process Intelligence Helped

  1. Routing rules are difficult to access until you correlate the sequence of activities with outcomes over 1,000’s of claims

  2. Often, 20%+ of claims bouncing back from offshore or BPO teams resulting in multiple touches and rework were identified

  3. Within 60 days, an assessment using process mining was able to identify changes that can be implemented immediately, often without IT involvement



Check out the table of contents for the rest of the claims stories

Our eBook Partner

Celonis is your gateway to Process Intelligence

About Celonis


Since 2011, Celonis has helped thousands of the world’s largest and most esteemed companies yield immediate cash impact, radically improve customer experience, and reduce

carbon emissions.

Its Process Intelligence platform uses industry-leading process mining technology and AI to present companies with a living digital twin of their end-to-end processes. For the first time, everyone in an organization has a common language for how the business runs, visibility into where value is hiding, and the ability to capture it.

Celonis is headquartered in Munich, Germany and New York City, USA with more than 20

offices worldwide.


32 views6 comments

Recent Posts

See All

6 Comments


Jones Miller
Jones Miller
3 days ago

When deadlines start piling up New Assignment Help USA comes through with excellent support. Their team ensures that every assignment is customized and aligned with academic standards. The process is straightforward, and their ability to deliver on time has taken a lot of stress off my shoulders.

Like

jack owen
jack owen
Jan 11

Our experts are available to help you with any difficulty you may be having with complex lab results, evolutionary theories, or cellular processes. We place a high value on precision and thorough comprehension, making sure that students not only finish their assignments but also acquire comprehensive knowledge of biological concepts. With the help of Bioinformatics Assignment Help, you can achieve academic success, solve life's challenges, and present assignments with assurance that demonstrate your command of the bioinformatics sciences. These applications check text for mistakes in syntax, grammar, punctuation, and spelling and provide correction suggestions to improve writing's clarity and quality.

Like

jasonry2786
Dec 31, 2024

You might come across psychologists working in any subject you are interested in, including social work, administration, athletics, health, schooling, and information technology. Considering that psychology encompasses the study of human behavior, it is not surprising to find people with training in this field applying their knowledge and skills in a variety of contexts. The paper should be generated based on vigorous research and conceptualization of the underlying critical factors. Our company's highly qualified psychology group of Psychology assignment helper service comprises vast experience in study and application in psychology. They have indeed written many short psychological papers that are available online and are renowned and a name for exceptional research services. With the support of their company, many students had…

Like

Luciana Jones
Luciana Jones
Oct 28, 2024

Maths will always be vital in many ways that help us grasp the scientific and operational principles of the world. Algebra, statistics, and calculus require precise math understanding. Without proper training, your findings will be invalid. Math assignments demand a lot of information, but with the correct statistics assignment assistance, you may succeed. Statistics assignment requires reviewing the primary topic's requirements to obtain the proper solutions. Statistics is easy to learn regardless of stream. The most crucial stage is to evaluate all preparation information before studying the topic. The learner must also work hard to generate well-planned, consistent output. If the audience isn't paying attention, the topic will deviate. Thousands of students worldwide seek the best online class help. There…

Like

maxwellmarco1727
Oct 25, 2024

Even with proctored tests, the service named pay someone to do my exam has experience writers who are efficient at completing assignments and exams on time. With this, you are guaranteed that the assignments they submit to you are 100% plagiarism-free and original. This is made possible by running through sophisticated programs and resources in the testing process of their work in terms of any duplication. Plagiarism and the duplication of other people's work are strictly not allowed in this organization, so you can always rely on it for sure. They have discovered proctored exams to you to be the most reliable method. Rest assured that you will never miss your exam, no matter how safe it is. We promise to…

Like
bottom of page