Industry
Insurance
Company Size
$28M
Technologies
Claims Processing Tools (FileHandler, IVOS, etc.), SharePoint, MS Office
Domain Area
P&C claims
The client, a Third-Party Administrator (TPA) specializing in claims administration and consulting services for the insurance and reinsurance sectors, faced significant delays in claim setup and processing. These delays were primarily caused by inaccurate or minimal data during the class setup, which hindered the efficiency of claims management. As a result, the client struggled with slower processing times and increased operational costs. To address this challenge, the client sought a solution that would streamline the claim setup process, improve data accuracy, and accelerate claim processing, ultimately enhancing operational efficiency and reducing time-to-resolution for claims.
Fulcrum Digital partnered with the client to streamline their Claims Setup Workflow, improving P&C claims processing. Our experts handled the entire lifecycle, from verifying reimbursement requests to cross-checking claim data in the David & Young (DY) Application. Key steps included efficiently entering claim details such as amounts, claim numbers, CPT codes, provider names, and service dates, ensuring data completeness and accuracy. We managed document uploads and emails for streamlined documentation, assigned claims to auditors for validation, and implemented tracking through DY for enhanced transparency and efficiency. This optimization led to faster claims processing, improved data accuracy, and reduced costs, enabling the client to focus on strategic growth.
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