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Claims Management

Client Challenge

Among the top three customer complaints against insurance companies is always claims processing delays. Despite scanning and electronically archiving their incoming communications, many insurance providers are still working with departmental dossiers that are not readily accessible across the organization, resulting in loss or duplication of documents, unauthorized access to confidential and private information and insufficient status updates. Simply locating and gaining access to these separate paper or electronic dossiers can take hours or days, impacting the integrity and speed of claim processing. With a growing universal trend toward integration and collaboration to maintain a single view of the customer, insurance companies face diverse challenges in sharing and accessing real-time case/customer information, activity and events in one place to quickly and efficiently resolve a case.

Enabling collaboration of knowledge workers and external experts on a claim and granting access (temporarily) to certain documents are also vital to complete critical tasks and processes. Working from the office, a VPN, the Web or mobile devices, claims management teams must securely access stored information, complete forms and upload data and documents to keep the claims process moving ahead efficiently and accurately. Collaborative claims systems must also ensure compliance with internal policies and protocols, as well as external regulations and legislation, leading to a requirement for audit trails on the participants, timing, data and specific workflow of any given claim activity.

Offer Description

Achieving a single customer view requires implementing a system to enable capturing, creating and managing case documents, accessing and routing these documents, recording them and triggering activity related to them. Papyrus Claims Management includes a complete document management system with a comprehensive facility for creating, capturing, indexing, storing, finding, viewing, sharing, editing, versioning and retaining a wide variety of document types.

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Single Customer View

Claims Process Overview - Liability case example:

  • Distributed scanning and classification of incoming mail
  • Recognition of incoming information to associate documents with existing claim file or trigger creation of new claim file
  • Incoming and outgoing case-relevant documents saved and stored to virtual liability case file (e-mails, photos, reports, legal/court documents)
  • Automatic or manual updates to case file overview, status and checklist with latest activity and data
  • Optimization of liability process using business rules, ad-hoc activity and user-trained agent
  • Integrated letter writing (cancellation letter, notification of claim, etc.) in a browser or fat client application for the claim worker and insurance agent
  • Efficient central output management for all case-related correspondence
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Letter writing and text editing using Wizards

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Letter writing and text editing using Wizards

The knowledge worker uses Papyrus Intuitive Business Layouter to describe its claims process in the company’s own business terms, applying documents as input and output to tasks and to control the boundaries of the process using business rules. Without programming the knowledge worker can upload documents, images, photos or create a new document using pre-defined and classified document templates during the lifecycle of the case, as well as define ad-hoc tasks and assign those to claim workers.

Tasks and activities define the case context and are visible along with case documents in the shared claims folder, where the status of the claim as a whole is determined by the combined state of all tasks and documents. Papyrus also offers monitoring on the claim and task level as well review of the case history, giving the responsible manager worker full control of and insight to performance and quality in servicing the claim.

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Case Management Dashboard (Widgets)

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Intuitive Business Layouter

To ensure both compliance and flexibility, Papyrus Claims Management can apply rules to document events for automation and case status tracking at any point in the process, including required predefined tasks and documents via the case template and also allowing the addition of ad–hoc activity and content at runtime.

The strength of Papyrus Claims Management is an integrated end-to-end solution combining data, business processes and rules, document creation, capture and output management with support for Dynamic Business Process Management in a single platform.

Value Delivered

Key Benefits/Value

  • Single communication & process platform is state- and event-driven and rule-based
  • Holistic customer view for end-to-end claims management
    • Out-of-the-box shared claim folder with different views based on claim status and user
    • Closes the loop with integration of inbound and outbound communication for full-circle response
    • Collaborative process for transparency and efficiency
    • Secure team access to claim and customer information
  • Single point of access to all information
  • Capture and classification of incoming mail
    • Reduced data entry errors
  • Efficient, centralized output management
  • Interface with all business applications and legacy systems
    • Any document type or object can be added to the claim
    • All claims centrally stored
  • Enhanced consistency and compliance with internal and external regulations
    • Flexibility for automation of all processes and future business changes
    • Archiving with retention policies
    • Multi-language support
  • Increased operational performance and results
    • Optimization of knowledge worker’s time
    • Increased efficiency in time to closure
    • Reduced implementation, maintenance and development costs
    • Reduced manual operations and minimal duplication of documents and data

Key Features

  • Collaborative platform for claims resolution.Shared case folder available to authorized users working on the case subject to specific security and access control rules
    • User authorization and authentication for selective access to experts
    • Status and task monitoring for auditing
    • Change management, digital signature, versioning, variant control
    • Support for collaboration - chat, e-mail, phone
  • Real-time access to common claim data, documents and activity
    • Activities, to-do’s, check lists
    • Calendar
    • Inbound and outbound communications
    • Tasks with priority and deadlines
    • Service tasks that perform automatic operations (send email, print, archive, call a Webservice, initiate another process)
    • Viewing and printing outgoing and incoming documents = based on authorization
    • Support for offline work and mobile platforms without additional programming
  • Process description in company’s business terms
    • Business Process Management Notation 2.2 support
    • Applying documents as input and output to tasks
    • Control of process boundaries using business rules
    • Monitoring tools and views suitable for reactive or proactive approach
    • On-the-fly definition of ad-hoc tasks and assignment to claim workers
  • Integrated processing of inbound communications
    • Classification and extraction of data from incoming forms, mail, fax and emails
    • Uploading documents, images, photos
  • Integrated outbound correspondence system
  • Integrated letter writing in desktop and browser with full word processing capabilities, including with spell check and hyphenation in many languages
  • Pre-defined and classified document templates
    • Generate and respond to letters, cancellations and claims
    • Access through browser or fat client interfaces
    • Accessible to knowledge workers, managers, sales team, business partners and customers
  • Customizable views can include different information, such as
    • Form showing claim data or content
    • Tasks history
    • Checklists
    • Discussions
    • Dashboard
  • Automatic process discovery and implementation in real time (UTA/Activity recorder)
    • Activity Recorder/Player supports the knowledge worker with repetitive tasks, minimizes user interaction and reduces errors
    • Recorded activities can be reused
    • User Trained Agent supports employee decision-making, learning from observed patterns
  • Business application and legacy system integration
    • Wide range of Adapters and Typemanager interfaces
    • Comprehensive document and object support - MS Office, SMS, chat session, wiki pages, HTML, XML, PDF, audio, video, CAD CAM, X-ray, photos, etc.
  • Long-term archiving of the case and its content with retention policies

Product Configuration: Claims Management

  • Papyrus WebRepository
    Central management, administration and control of document content and access, including defining business document building blocks and layout, data and logic; versioning, validation and auditing; business rule and process definition and management; record management; sign-off and change management; user authorization and security functionality.
  • Papyrus Adapter/LDAP
    Interfacing directly with defined user roles.
  • Papyrus Adapter/MQ Series or SOAP Adapter
    Definable messaging interface for business data, compiler- and platform-independent.
  • Papyrus Client/Desktop for outbound correspondence
    Business users work with templates, assembling content and creating new building blocks, text editing with spell check, business rule (NLR) and process definition, i.e. sign off, local or central print. Users enter data into an intelligent Webform for ad-hoc delivery of a dynamically generated PDF business document on the server. Papyrus Client with full-text editing capabilities can be installed as a thick client or plug-in for the browser.
  • Papyrus Designer Package
    Outbound document/letter design, data variable definition, complex logic definition.
  • Papyrus WebArchive
    Short-term archiving for customer care, Internet delivery and long-term archive. Stores and enables instant retrieval of indexed electronic documents and content, data, video, photos and images in an object database. Uses a depot structure for distributed storage and common key information.

Product Configuration: Inbound

  • Papyrus Designer Capture
    Graphical definition for extracting text keywords and data fields from scanned image, e-mail, SOAP message and fax.
  • Papyrus Server/FreeForm®
    Automated “machine-learning-technology”, pattern recognition, contains OCR/ICR (5 engines) and “Context Fuzzy Record Associator”, image correction, document classification, data extraction and validation, e-mail text classification, distributed archiving and automated content replication.
  • Papyrus Client Capture
    Manual correction on the desktop or in the browser.
  • Papyrus Adapter/POP3
    Email classification, delivery and/or response; alternatively, trigger a formatting job on another node in the system.

Optional Components: Centralized Batch Formatting and Output Management

  • Papyrus DocEXEC and DocEXEC/PDF
    High-speed formatter for batch, online and user-interactive documents on 11 platforms generating AFP and PDF formats with indexes, OMR and barcodes, table of contents, page sorting, print last page first, etc.
  • Papyrus PrintPool
    Bundling, sorting and merging of different output documents generated at different times into one envelope per addressee, with mail optimization for best mailing discounts, i.e., priority mail, sort upon specific criteria, optional print or Web presentment, fax and e-mail SMTP and more.
  • Papyrus Server (IPDS, PS, e-mail, fax)
    Printing AFP and PDF to all standard laser printers, e-mail and fax.