Cognitive document processing: A competitive differentiator for payers

Each day, health insurers process vast amounts of claims data for settlement – and even in today’s digital world much of it is in paper format. Moreover, electronically submitted data often consists of scanned images of insurance forms and medical documents.

The bottom line? While payers gather a lot of data, it’s rarely in a useful format for fast data processing. Adding to the complexity are the sensitive nature of members’ health information as well as compliance with privacy regulations such as HIPAA in the United States.

Manual medical claims processing is time consuming and can be prone to error. If vital data is misread, risks of regulatory non-compliance and settlement delays go up.

Data capture bottlenecks undeniably impact processes across the insurance value chain. A lack of structured data can cripple a firms’ automation initiatives – such as those that leverage robotic process automation (RPA) and straight-through processing (STP).

With 48.4% of health insurers saying they use RPA to streamline firm processes, according to the World Insurance Report (WIR) 2018, the need of the hour appears to be an efficient data capture system that can seamlessly process health claims and enhance operational effectiveness.

Enter cognitive document processing (CDP).

By leveraging optical character recognition (OCR) and intelligent character recognition (ICR) engines, a CDP solution can classify and contextually extract data with high accuracy while validating addresses and adhering to industry-specific rules. The resultant structured output can be fed into downstream RPA or core systems for claims management and billing.

CDP pays off for payers and policyholders

CDP automates and accelerates document processing, which frees staff to handle only the exceptions and enables them to perform more complex, value-added tasks. Because CDP allows insurers to make decisions more quickly, they can deliver faster response times and beef up customer experience and satisfaction.

Within today’s competitive industry landscape, faster response time can be a distinguishing characteristic that differentiates one insurer from the other.

Through automated document processing and rapid delivery of structured information for processing, CDP boosts insurers’ operational efficiency while delivering significant cost savings.

Capgemini’s end-to-end cognitive document processing solution automates the intake, organization, and evaluation of digital documents – rapidly, accurately, securely, and at a reduced cost.

The solution, offering CDP as a service, employs machine learning and artificial intelligence to power the automated extraction of information from unstructured documents and is bundled with business process outsourcing capabilities to guarantee accuracy levels. What’s more, it enables straight-through processing thanks to easy integration with core systems and robotic applications, which helps insurers accelerate their business.

Interested in more information? Click here for details about Capgemini’s CDP solution for insurance or contact me directly.

Michael Carroll

Expert in Insurance

A highly accomplished and multifaceted INSURANCE CLAIMS EXECUTIVE with proven global and domestic expertise in global claims, specialty and personal LOBs, target operating model design and execution, acquisitions and transitions, transformation analysis, vision execution, product line management, large loss management, and sales, marketing and underwriting.
Possesses an established record of building performance-driven and measured organizations, from claim registration through adjudication. Leverages demonstrated unique ability to translate vision and strategy into executable action and entrenched day-to-day practice to positively impact the top and bottom line.