Insurance Claim Status

As with the auto insurance industry, medical insurance claims create numerous calls each day that take a long time to service. Often, the nature of the call has to do with an inquiry regarding the simple disposition of a claim, and whether or not the claim has been processed and paid. The typical length of such a transaction if done manually is anywhere from three to five minutes, including holding time. This causes a service level problem for callers who get frustrated and hang up. Live operators and claims adjusters are required to explain policy provisions, track down special problems, and deal with exceptions. These adjusters and operators can do a superior job in servicing special calls if they are relieved from the duties of servicing simple informational calls.

Call processing alleviates much of this problem by allowing policy holders to access claims information on their own. In most cases, an automated system will qualify the call, and include provisions for routing the caller to a live operator. This type of system will ask the caller to input the date of the claim and sometimes the dates of service in question. When this data is matched up with the policy holder’s account number and identification code, an inquiry is made from the call processing system to the insurance company’s mainframe computer in order to come back with the claims status. Information is then spoken out to the caller, which may include a request for more data from the policy holder in order to process the claim.

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