Client:
TPA
Industry:
Insurance
Region:
South
How a TPA handled all claims assigned during a catastrophe without loss of revenue
AC case study
90%
decrease in intake time
The Challenge
The third-party administrator (TPA) faced significant challenges due to the seasonal nature of catastrophes, such as hurricanes, which drive their claims processing operations. With a 50-person team, including desk administrators responsible for processing and administrating claims from the initial FNOL intake, to assigning and dispatching to adjusters, to managing the claim, to ensure the quality, and finally to create the invoice. The primary difficulty lies in how a different member of the team did each of these tasks; and when managing the fluctuating workload caused by these seasonal catastrophes, the team often needed to higher and train lots of temp. workers in each position. Attempting to fulfill peak demands by contracting non-fulltime employees (1099s) has also proven unreliable, as it is challenging to secure enough contracted personnel at short notice during a catastrophe.
Especially in the year of adopting Catalyst Claims, there was been a low level of catastrophic events; so the team was particularly short-staffed when a catastrophic event occurred.
Specific challenges in their day-to-day tasks included:
Receiving claims assignments via email, often in varying formats.
Manually keying in the claims information into their claims management system.
Limited ability to scale operations quickly during high-demand periods.
Inefficiencies due to desk administrators juggling multiple responsibilities.
Loss of potential revenue due to unprocessed claims during peak periods.
The company recognized the need for a solution to streamline their claims process and handle the fluctuating demand more effectively. However, investing in an internal tool was not feasible due to the size of their business and their lack of technological expertise. Developing such a solution would divert resources from their core operations and ultimately be cost-prohibitive. Therefore, they sought an external solution that could provide the necessary scalability and efficiency without the need for significant internal investment.
The Approach
In response to the challenges faced by the third-party administrator (TPA) during catastrophic events, the company adopted Catalyst Claims to enhance their claims process. This solution provided key integrations and automation to meet their needs:
Catalyst automatically scans all Outlook inboxes to identify and isolate claims-related emails, including attachments from carriers, ensuring no crucial information is overlooked.
The system extracts relevant details from each claim, such as policy numbers, loss descriptions, and contact information, directly from the identified emails and attachments.
Based on the information extracted, Catalyst algorithmically picks the best adjusters and loads up a queue
Manual QA to confirm the information and approve the queue for adjusters to be offered the claim
Approved claims are automatically uploaded to the claims management system via an API, significantly speeding up the intake workflow and reducing manual data entry errors.
Adjusters are notified via email and text to accept the claim. If they accept within 2 hours, they are automatically sent the claim information. Otherwise, the next adjuster on the queue is automatically notified the same way and the process repeats until the claim is accepted.
Catalyst continuously checks and supports the Adjuster during the adjusting process.
Afterwards, based on the SOP of the carriers the TPA was working with, Catalyst automatically detects QA errors and suggests corrections.
Finally, Catalyst creates the invoice and closes the claim!
By implementing Catalyst, the TPA was able to effectively manage the fluctuating claims intake during peak periods, ensuring scalability and operational efficiency without the need for significant human capital investments.
The Results
The deployment of Catalyst Claims led to significant improvements in efficiency and accuracy for the third-party administrator (TPA).
Achieved a 90% reduction in the processing time required to administer their claims when combining the time saved from accelerated intake, automatic triage, claims management, and invoicing, significantly accelerating the claims intake workflow.
Maintained compliance by automatically checking the licensing of new adjusters onboarded to manage cat claims.
Consistently delivered less than 1% leakage in claims adjusted as observed 3 months after the catastrophic event, reducing errors and increasing reliability in the claims processing workflow.
By leveraging Catalyst’s automated workflow automation capabilities, the TPA was able to automatically scale and handle any load during catastrophes. This ensured that their existing staff was sufficient to manage all the claims, regardless of volume. Additionally, the pricing and usage of Catalyst scaled appropriately, up and down, providing a cost-effective solution that matched their operational needs.
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