Improve your Insurance Claim Process with QPR ProcessAnalyzer | QPR

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21 February 2018

Improve your Insurance Claim Process with QPR ProcessAnalyzer

Insurances are there to protect when something unexpected has occurred and there is a need to cover for any losses. Before reimbursements are paid and losses are covered for,
a claim has to be handled and approved by the insurer. This process can contain numerous steps and involves multiple different steps, creating a complex process. Handling Insurance Claims is a daily process in the insurance domain and a high volume of claims are handled on the high corporate level, producing large amounts transactional data. Using QPR ProcessAnalyzer, this data is analyzed to gain an understanding what occurs in the claims process and how it is performing.
Optimizing the process and having the bottlenecks identified and resolved helps the process to be more compliant with the internal business rules regarding claims and in turn, creates a much better customer experience and retention.
With Process Mining, the transactional data produced by handling insurance claims can be used for solving the issues related to handling the claims that come in. This blog post shows how you are able to do instant findings on possible improvement areas using QPR ProcessAnalyzer in just a few minutes.

When starting to analyze a process, it is good to know what kind of Key Performance Indicators and Business Rules there are for the process. This gives a good guideline on what to look forward to
in the process analysis phase. QPR ProcessAnalyzer also assists in setting new KPIs and metrics. In terms of an insurance claim,
one key KPI is the duration of a case settlement. This is related to the handling time of an insurance claim. Using QPR ProcessAnalyzer, the lead times are be instantly visualized and possible bottlenecks in the process are instantly inferred.

Looking at the Duration Analysis, we see that we have a number of cases that are not conforming to the KPI of handling a case in 9 weeks or less. This duration is instantly calculated using QPR ProcessAnalyzer's core and thus reflects the situation as it occurs in the data. As we are interested in what is causing these delays, we can select the nonconforming cases for analysis.  We also have an interest in seeing what kind of path these delayed cases are taking, so we will use Influence Analysis for Flowchart, giving us the visibility on what is the most common process flow for our selected cases

By viewing the flowchart, we can easily see that the major contribution to the delays is the external appraisal. As we have found out a cause for delays in the overall process, we want to look into further and see what is causing for cases to be escalated to a third party.

Influence Analysis results show that the Austin region relies to external appraisal more than normal

We start our Influence Analysis by switching to Flowchart Analysis and selecting the external appraisal requested event type. Looking at the results Influence Analysis for Case Attributes gives us, it is revealed that Austin branch is more reliant on escalating to a third party. To dive deeper into what is causing the Austin region to escalate, we just switch our main analysis to Profiling Case Analysis.

Using Profiling Case Analysis, we can focus on the Austin region and the cases it has dealt with and that is where we need a filter. Just opening up our Popup Menu allows us to create a filter quickly. After creating the filter, we move forward to more focused analysis to find out what cases in the Austin region are causing escalations to a third party.

As we had done previously, clicking on the event type shows the Influence Analysis for Case Attributes results instantly. Looking at the table, we can instantly see what is the main cause for having an external appraisal performed on an insurance claim. In the Austin region, the most common reason is  Healthcare related insurance claims. 

With only a few clicks, we were able to look into the process of insurance claims and do key findings based on the data extracted from transactional information systems. We found out that the major cause of delays was having an external appraisal performed
on a claim in question. Furthermore, we were able to note that our Austin branch was relying on these external appraisals. Doing further drill-downs, we were able to see that Healthcare related claims were the major cause of having a third party evaluate the claim.

QPR ProcessAnalyzer gives an access to improving the performance of an Insurance Claim process and can be extended into other areas of the process.

If you are interested in seeing more applications for QPR ProcessAnalyzer in the insurance claims process, check out our webinar below.

Watch on-demand

Riku Mikkonen's picture
Riku Mikkonen
Product Marketing Manager