Insurance claims processing, whether medical or auto insurance, is a meticulous process. Raising a claim properly, processing it, validating the claim and disbursing the payment usually takes time because all the documents have to be carefully verified before the claim is rejected or accepted. Companies can outsource insurance claim process to competent outsourcing partners to ensure smoother and faster claims processing. Whether your business deals with medial claims or auto insurance claims, the basic steps would remain the same. Here are the basic 5 steps involved in insurance claims processing in general:
Submit the claim to your broker
The insurance claim is submitted in the format required to the broker. The claims management team will convert the physical application and the supporting documents into digital format for verification, validation and further processing. This process has to be done carefully as the details being input should be accurate or else the claim may be rejected. The submitted claims are then passed on to the verification and validation team.
Broker initiates claims validation
The broker initiates the claim validation process. All documents are checked for accuracy and validity of the claim. Various online and offline sources are required for verification and validation of insurance claims. Depending upon the type of claim and location, physical verification may be required. For example, in case of an accident claim or fire claim, a physical verification may be required.
Policy is Reviewed
The policy documents are reviewed in detail to check whether the claim is valid or not. There may be certain issues that are not covered by certain insurance policies. Before the claim can be accepted, whether it stands valid under the insurance scheme opted by the customer is checked and confirmed. Otherwise, the claim is rejected. For example, if a person files a health insurance claim for a treatment which is not covered in his scheme, the claim will be rejected.
Damage is evaluated
If the claim is valid and verified to be genuine, the damage is evaluated. This will decide how much of the claim should be sanctioned and accordingly, the payment to be disbursed. Sometimes, the policy may allow only part pay for the certain damages. Such details are checked and confirmed and once the valuation is completed, the recommended payment disbursal against the claim is provided to the insurance company.
Payment is disbursed
The insurance company receives the claim documents along with the supporting documents, the verification and validation reports and the damages evaluated. Typically, for an accident insurance claim, the amount is reimbursed after the actual expenses are met. In the case of medical claims, sometimes the entire expenses are paid off by the insurance company without taking money from the customer. This depends upon the type of policy taken.
For all types of insurance claims, these are the basic steps involved. Depending upon the insurance company and the scheme selected, the claims processing may vary a little. But outsourcing insurance claims processing offers the most cost-effective and efficient alternative to maintaining an in-house team exclusively for insurance claims processing.