Why Insurance companies need back office support?

Why insurance companies need back office support

These days the health insurance sector is becoming more competitive. In a dynamic business environment, medical insurance payers need to concentrate more on marketing, customer retention, and striking a balance between their profitability, mission, and vision. Back office support comes into the picture to help the organization in achieving their ultimate goal without affecting the overall profit. Large volumes of claim and insurance data accrue on a daily basis from various insurance processes that require effective back office solutions. Back office services can automate insurance claim processing services to provide a quick and efficient outcome. These services consist of following intermediate processes which can be effectively handled by the back office:

  • Insurance claim setup
  • Insurance claim eligibility
  • Insurance claim form verification and processing
  • Claim document imaging
  • Claim validation and examination
  • Disbursement
  • Full claim adjudication
  • Fast track adjudication
  • Claim support and auditing
  • Quality Control

An organization’s back office support and management can significantly impact its success. High-quality back office support promotes enhanced business efficiency and improved bottom-line. These functions are not directly related to customer support, but it definitely enhances customer experience. Insurance companies are facing a lot of pressure due to market deregulation and natural disasters. When it comes to medical insurance claims process, the challenges are multifaceted which includes volume, accuracy, the speed of processing, and regulatory compliance. This can be done with the help of an efficient back office which can be located away from the company headquarter to minimize the infrastructure cost. It can also be outsourced to get the improved and quality result. The back office, whether in-house or outsourced, can create the following top line and bottom line impacts which are crucial for the success of health insurance companies.

  • Reduced claims processing time
  • Increased customer acquisition and retention
  • Effective risk management
  • Enhanced claims handling

Claims processing is one of the core financial drivers of an insurer's business. Even inside the back office, there may not be anyone who truly understands the whole process. There are a lot of reasons for this variation which includes internal policies, best practices, investment in technology, type of claim, and deadline. Technology is an especially important driver with the advent of electronic claims submission and even real-time adjudication of claims. Some insurers have made great advances in health insurance claims processing with auto-adjudication programs and can process a large number of claims that way. Analytics is also an especially rapidly developing area in claims processing. Like other industries, insurers are beginning to realize and harness the power of "big data" in the claim process. So, by hiring skilled back office personnel, the insurance company can be highly benefited in terms of growth and profit.

While most of the challenges faced by insurance companies are similar to the challenges faced across all industries, insurers must particularly focus on increasing cost effectiveness and better managing risk. At the same time, insurers must enhance agent and client satisfaction with the support of back offices to increase market share. There are several aspects of insurance claims processing where back office need to support in the following manner:

  • Dedicate a whole team to insurance claims administration needs
  • Usage of advanced technology software in claims processing
  • Build teams with only the skilled and brightest members working together to serve a common goal
  • Provide robust infrastructure to maintain smooth operations and faster turnaround times
  • Provide a degree of continuity, quality assurance, and intellectual property protection assurance