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Improve Your Claims Processing

Your 6-step guide to optimize claims processing in Sapiens ClaimsPro.
Improve Your Claims Processing
Challenges (11) Goals (12) 6 Steps Preview Outcomes Data FAQs (4)
Process: Claims Processing
System: Sapiens ClaimsPro
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Optimize Claims Processing in Sapiens ClaimsPro for Faster Resolution

Claims processing can often suffer from delays, compliance issues, and inconsistent resolutions. Our platform helps you uncover hidden inefficiencies and identify root causes of bottlenecks. Streamline your entire claims workflow to enhance operational efficiency and boost customer satisfaction.

Download our pre-configured data template and address common challenges to reach your efficiency goals. Follow our six-step improvement plan and consult the Data Template Guide to transform your operations.

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Why Optimizing Claims Processing is Critical for Your Business

Claims Processing is the lifeblood of any insurance operation, directly impacting customer satisfaction, financial performance, and regulatory compliance. Inefficient claims handling, even within robust systems like Sapiens ClaimsPro, can lead to substantial financial losses through delayed payments, increased operational costs, and unnecessary reserves. Furthermore, slow or inconsistent claims resolution can severely damage your reputation, erode customer trust, and lead to policyholder churn. The inherent complexity of managing diverse claim types, navigating regulatory requirements, and coordinating multiple stakeholders means that manual oversight often misses subtle yet significant inefficiencies. Understanding the true flow and identifying the specific points of friction within your Claims Processing operations, powered by Sapiens ClaimsPro data, is not just beneficial—it’s essential for sustained business success and competitive advantage.

How Process Mining Illuminates Claims Workflows in Sapiens ClaimsPro

Your Sapiens ClaimsPro system captures a wealth of transactional data, logging every activity, event, and status change for each claim. Process mining takes this raw event data – from "Claim Submitted" to "Payment Issued" – and visually reconstructs the actual end-to-end journey of every single claim. Unlike traditional analytics that show what should happen or summary statistics, process mining reveals what does happen. This means you can:

  • Visualize Real Workflows: See all executed paths, even the deviations from the standard process, identifying where claims get stuck or take unexpected detours within Sapiens ClaimsPro.
  • Pinpoint Bottlenecks: Precisely identify activities or handoffs that cause delays. Is the bottleneck in "Initial Review Performed," "Investigation Completed," or "Payment Authorized"? Process mining shows you the exact waiting times and queues.
  • Analyze Rework and Loops: Detect instances where claims repeatedly cycle between statuses, such as multiple "Additional Information Requested" events, indicating process friction or unclear communication.
  • Quantify Cycle Times: Measure the precise duration of each process step and the overall end-to-end claim resolution time, offering a factual basis for performance improvement initiatives. This helps you understand how to reduce Claims Processing cycle time effectively.

By leveraging the detailed event logs from your Sapiens ClaimsPro system, process mining provides an X-ray view into your claims operations, offering unparalleled transparency and actionable insights.

Uncovering Key Improvement Areas within Your Claims Operations

With a clear understanding of your claims process derived from process mining, you can target specific areas for significant improvement:

  • Streamlining Adherence to SLAs: Identify claims that consistently breach service level agreements and investigate the root causes, whether it’s resource allocation, approval delays, or external dependencies.
  • Optimizing Resource Allocation: Analyze adjuster workloads, handoff times, and task assignments to ensure an even distribution and minimize idle time or burnout. This could involve re-evaluating team structures or automation opportunities within Sapiens ClaimsPro.
  • Enhancing Compliance and Audit Readiness: Automatically detect non-compliant process paths or skipped mandatory steps, ensuring that every claim adheres to regulatory requirements and internal policies. This proactive identification is crucial for risk management.
  • Reducing Manual Touchpoints and Rework: Pinpoint repetitive manual tasks or frequent re-dos (e.g., repeatedly requesting the same information) that can be automated, simplified, or better supported by Sapiens ClaimsPro features.
  • Identifying Best Practices: Compare the performance of different process variants or teams to identify successful strategies that can be scaled across the organization, leading to more consistent and efficient Claims Processing.

Tangible Outcomes: Elevating Your Claims Performance

Implementing process-mining-driven improvements for your Claims Processing in Sapiens ClaimsPro leads to concrete and measurable benefits across your organization:

  • Significantly Reduced Cycle Times: Expedite claim resolution, leading to faster payouts and higher policyholder satisfaction. This directly addresses the goal of how to reduce Claims Processing cycle time.
  • Lower Operational Costs: By eliminating bottlenecks, reducing rework, and optimizing resource utilization, you can achieve substantial savings in operational expenditure and adjuster time.
  • Boosted Compliance and Reduced Risk: Proactively identify and rectify deviations from regulatory and internal standards, mitigating financial penalties and reputational damage.
  • Enhanced Customer Experience: Deliver consistent, transparent, and quicker claim resolutions, fostering trust and loyalty among your policyholders.
  • Data-Driven Decision Making: Empower your management with factual, objective insights into process performance, enabling informed decisions for strategic improvements and system enhancements within Sapiens ClaimsPro.

These outcomes translate into a stronger competitive position, improved financial health, and a more agile, customer-centric organization.

Getting Started with Claims Processing Optimization

Transforming your Claims Processing through process optimization doesn't require a complete overhaul or extensive technical expertise. By connecting to your Sapiens ClaimsPro data, process mining tools can quickly deliver the deep insights you need to understand, analyze, and dramatically improve your claims workflows. Start leveraging the power of your existing data to uncover hidden efficiencies and drive tangible improvements across your Claims Processing operations today.

Claims Processing Claim Resolution Insurance Claims Loss Adjustment Compliance Fraud Detection Policy Holders Claims Management

Common Problems & Challenges

Identify which challenges are impacting you

Long cycle times for claims processing lead to frustrated policyholders, increased operational costs, and potential regulatory penalties. Delays in resolution directly impact customer satisfaction and the insurer's reputation.
ProcessMind visualizes the end-to-end journey of every claim in Sapiens ClaimsPro, identifying bottlenecks and activity durations. By analyzing "Claim Submitted" to "Claim Closed" cycles and intermediate steps like "Investigation Completed" to "Claim Decision Made", it pinpoints where delays occur, allowing for targeted process improvements.

Claims of similar types or severity often follow different, non-standardized paths, leading to varied outcomes, compliance risks, and unpredictable processing times. This lack of consistency makes it difficult to ensure fairness and efficiency.
ProcessMind maps all actual process variations within Sapiens ClaimsPro, showing how claims diverge from the optimal path. It highlights deviations based on "Claim Type" or "Claim Severity", revealing non-standard sequences and enabling the enforcement of best practices for consistent and compliant handling.

Claims repeatedly cycling back for additional information, re-review, or correction significantly inflate processing costs and extend resolution times. This re-work often stems from incomplete initial submissions or unclear process steps.
ProcessMind visualizes process loops, such as multiple "Additional Information Requested" or claims moving back from "Investigation Completed" to "Initial Review Performed" within Sapiens ClaimsPro. It quantifies the frequency and identifies the root causes of these re-work cycles, optimizing the flow.

Specific approval steps, such as "Payment Authorized" or "Claim Decision Made", often become choke points, delaying the entire claims resolution process. These bottlenecks can lead to a backlog of claims and missed service level agreements.
ProcessMind identifies specific activities or resources ("Assigned Adjuster", "Department") that frequently cause delays within Sapiens ClaimsPro. It measures the waiting times between "Loss Assessed" and "Claim Decision Made" or prior to "Payment Authorized", revealing where resources are overutilized or where approvals are stalled.

Deviations from mandatory process steps or required documentation lead to compliance risks, fines, and reputational damage. Ensuring every claim adheres to internal and external regulations is critical but challenging to monitor manually.
ProcessMind compares actual claims paths in Sapiens ClaimsPro against defined compliance models, highlighting every instance where a claim deviates from a mandatory sequence or misses a required activity, such as "Initial Review Performed" before "Investigation Started", enabling proactive compliance management.

Uneven distribution of workload among adjusters or departments leads to some resources being overwhelmed while others are underutilized. This inefficiency impacts productivity, staff morale, and overall claims throughput.
ProcessMind analyzes activity volumes and durations per "Assigned Adjuster" or "Department" within Sapiens ClaimsPro, revealing workload imbalances and identifying where resources are overtaxed or idle. This data-driven insight supports optimized staffing and task distribution.

Failure to meet "Resolution Target Date" commitments impacts customer satisfaction, increases escalations, and can incur penalties. Understanding why these targets are missed is crucial for improving service delivery.
ProcessMind directly compares actual claim closure dates against "Resolution Target Date" for each "Claim ID" in Sapiens ClaimsPro. It then drills down to identify the specific process paths, delays, or activities that contribute most frequently to missed deadlines, allowing for preventative measures.

Unnecessary manual interventions or inefficient handoffs between stages introduce delays and increase the risk of errors in claims processing. Identifying these non-value-adding steps is key to automation and streamlining.
ProcessMind uncovers hidden manual activities or sequential dependencies that extend cycle times within Sapiens ClaimsPro, often showing unexpected transitions between departments or systems. It visualizes the actual flow, revealing opportunities to automate or eliminate redundant manual tasks.

Elevated operational costs per claim due to inefficiencies, re-work, and extended cycle times directly impact profitability. Identifying cost drivers is essential for optimizing the claims department's budget.
ProcessMind correlates process variations, re-work loops, and lengthy activity durations in Sapiens ClaimsPro with associated resource and time costs. By highlighting the most expensive paths and bottlenecks, it provides insights for cost reduction initiatives.

Stakeholders and policyholders often lack real-time, accurate visibility into a claim's progression, leading to frequent inquiries, administrative overhead, and diminished trust.
ProcessMind provides a dynamic, real-time view of every "Claim ID" and its current "Claim Status" within the Sapiens ClaimsPro workflow. It visualizes exactly where each claim is in its journey and predicts potential delays, offering unprecedented transparency for internal teams and external communication.

Inconsistent "Settlement Amount" for similar "Claim Type" or "Claim Severity" can indicate bias, errors, or a lack of standardized assessment, leading to policyholder dissatisfaction and potential legal challenges.
ProcessMind analyzes the end-to-end paths for claims grouped by "Claim Type" and "Claim Severity" leading to their "Settlement Amount" in Sapiens ClaimsPro. It identifies process variations or deviations that correlate with significant differences in final settlements, pinpointing areas for standardization and fair outcome delivery.

Typical Goals

Define what success looks like

This goal aims to significantly shorten the total time it takes for a claim to be processed from submission to payment in Sapiens ClaimsPro. Faster resolution directly improves customer satisfaction, reduces operational costs associated with prolonged handling, and enhances the overall efficiency of the claims department. It means getting policyholders their settlements quicker.ProcessMind uncovers the precise activities and paths causing delays, highlighting bottlenecks and identifying opportunities to remove idle times or redundant steps. By analyzing cycle times for each stage, it helps establish new benchmarks and monitor progress toward reducing average claim resolution time by 15-30%.

Achieving this goal means ensuring that all claims of a similar type follow a consistent and optimized path within Sapiens ClaimsPro, reducing variability and error. Standardized processes lead to predictable outcomes, easier training for new adjusters, and a higher quality of service, ultimately impacting regulatory compliance and operational predictability.ProcessMind provides a visual discovery of all actual claim paths, immediately highlighting deviations from the ideal process model. It helps define and enforce optimal paths, identifying non-compliant or inefficient variants, and allowing for targeted training or system configuration changes to standardize the workflow by up to 20%.

This goal focuses on minimizing instances where claims need to be revisited, re-entered, or sent back due to errors, missing information, or incorrect processing in Sapiens ClaimsPro. Reducing rework saves significant time and resources, prevents delays, and improves data accuracy, contributing to lower operational costs and enhanced policyholder trust.ProcessMind pinpoints the exact stages and reasons for rework loops, identifying root causes such as incomplete initial reviews or data entry errors. It quantifies the impact of rework on cycle times and costs, enabling targeted interventions to eliminate up to 25% of re-entry or resubmission activities.

The objective here is to speed up decision-making and authorization steps within the Sapiens ClaimsPro workflow, particularly in critical approval stages. Faster approvals mean claims move through the system more smoothly, reducing overall cycle time and improving liquidity management for both the insurer and the policyholder.ProcessMind precisely identifies where claims are spending excessive time waiting for approval, uncovering resource constraints or complex authorization matrices. It allows for analysis of approval step durations and helps redesign approval hierarchies or implement automation, potentially cutting approval times by 30-40%.

This goal is paramount for mitigating legal and financial risks by guaranteeing that all claims processing activities within Sapiens ClaimsPro adhere strictly to industry regulations and internal policies. Full compliance protects the organization from penalties, maintains its reputation, and builds trust with regulators and customers.ProcessMind automatically compares actual claim paths against predefined compliance models, instantly flagging any deviations or non-compliant steps. It provides an auditable trail of all claim activities, allowing for proactive identification and rectification of compliance gaps, reducing regulatory risks by ensuring 100% adherence.

This goal aims to ensure that claims adjusters and other personnel are assigned tasks efficiently and their workloads are balanced across the Sapiens ClaimsPro system. Optimized resource allocation leads to higher productivity, reduced burnout, lower labor costs, and a more consistent claims processing output.ProcessMind provides insights into workload distribution and identifies bottlenecks caused by individual resource limitations or uneven task assignments. It helps reallocate resources more effectively, identify training needs, or automate routine tasks to free up skilled adjusters, improving resource efficiency by 10-20%.

This goal is about consistently meeting or exceeding established deadlines for resolving claims in Sapiens ClaimsPro. Failing to meet resolution targets can lead to customer dissatisfaction, potential penalties, and increased administrative overhead. Achieving this improves customer trust and operational predictability.ProcessMind tracks the progress of each claim against its target resolution date, identifying specific points in the process where delays accumulate and why. By analyzing historical data, it helps proactively intervene on at-risk claims and refine target setting for future claims, boosting on-time resolutions by 15-20%.

The objective is to identify and automate manual, repetitive tasks within the Sapiens ClaimsPro workflow that consume excessive time and are prone to human error. Automation reduces processing time, increases accuracy, and allows human resources to focus on more complex, value-added activities, thereby lowering operational costs.ProcessMind maps out all activities, highlighting manual steps and their impact on overall cycle time and cost. It identifies prime candidates for Robotic Process Automation (RPA) or system integrations, enabling organizations to automate up to 40% of routine data entry or verification tasks.

This goal focuses on decreasing the total expenses associated with processing a single claim from start to finish within Sapiens ClaimsPro, including labor, system usage, and potential rework costs. Lowering the cost per claim directly impacts the company's profitability and competitive advantage.ProcessMind provides a granular view of resource consumption and identifies cost drivers at each process step, such as excessive handoffs, redundant tasks, or extended cycle times. By streamlining processes and reducing inefficiencies, it can contribute to a 10-20% reduction in the average cost to process a claim.

This goal aims to provide clear, real-time visibility into the current stage and progress of every claim within Sapiens ClaimsPro for all stakeholders, including adjusters, supervisors, and policyholders. Enhanced transparency improves communication, reduces inquiries, and builds confidence in the claims handling process.ProcessMind delivers an always-on, real-time X-ray of the claims process, making the true status and progress of every claim visible. It identifies where information delays occur and helps implement dashboards and alerts to provide instant updates, improving transparency and reducing status-related inquiries by 20-30%.

This goal addresses inconsistencies in how similar claims are ultimately settled, aiming for fair, equitable, and predictable outcomes within Sapiens ClaimsPro. Standardizing settlement calculations reduces the risk of unfair practices, enhances compliance, and improves the overall reputation and financial predictability of the insurer.ProcessMind can analyze the decision-making paths leading to various settlement amounts for similar claim types, identifying where discretion leads to significant variations. It helps uncover the factors contributing to these discrepancies, allowing for the establishment of clearer guidelines and training to standardize settlement calculations by 10-15%.

This goal focuses on reducing the time it takes to make final decisions on complex or unusual claims that require significant investigation and multiple approvals within Sapiens ClaimsPro. Quicker decisions for these claims can significantly reduce overall claim cycle times and improve policyholder satisfaction in challenging situations.ProcessMind identifies the specific activities and stakeholders involved in complex claim pathways, revealing where delays occur in information gathering or expert consultation. It helps visualize dependencies and identify opportunities for parallel processing or improved communication protocols, potentially speeding up complex claim decisions by 20%.

The 6-Step Improvement Path for Claims Processing

1

Download the Template

2

Export Your Claims Data

3

Upload Your Claims Dataset

4

Analyze Claims Process

5

Implement Key Improvements

6

Monitor Process Performance

1

Download the Template

What to do

Access the pre-built ProcessMind Excel template specifically designed for Claims Processing. This template provides the correct structure for your Sapiens ClaimsPro data.

View Data Template Guide Download Template
Why it matters

Starting with the right data structure ensures compatibility and accuracy, laying a solid foundation for meaningful process analysis.

Expected outcome

A ready-to-use Excel template tailored for efficient claims data collection.

YOUR CLAIMS INSIGHTS

See Your Claims Journey, Discover Key Bottlenecks

ProcessMind reveals the true path of every claim, highlighting deviations, rework, and compliance gaps. Gain a clear, visual understanding of your entire workflow to drive targeted improvements.
  • Visualize actual claims processing flows
  • Pinpoint delay root causes in Sapiens ClaimsPro
  • Identify compliance breaches and rework loops
  • Quantify impact of process changes on claims
Discover your actual process flow
Discover your actual process flow
Identify bottlenecks and delays
Identify bottlenecks and delays
Analyze process variants
Analyze process variants
Design your optimized process
Design your optimized process

TYPICAL OUTCOMES

Transformative Outcomes in Claims Processing

By applying process mining to your Sapiens ClaimsPro data, organizations uncover critical bottlenecks and inefficiencies in their claims workflows. These outcomes represent typical improvements observed in key performance areas.

0 % faster
Faster Claim Cycle Times

Average reduction in end-to-end processing

Identify and eliminate bottlenecks to significantly reduce the time from claim submission to closure, enhancing customer experience.

0 % fewer
Reduced Rework & Resubmissions

Decrease in claims requiring additional info

Pinpoint root causes of rework loops and additional information requests, leading to a more streamlined and efficient initial claim processing.

0 % higher
Increased On-Time Resolution

Higher percentage of claims meeting deadlines

Ensure more claims are resolved within target dates by optimizing process paths and proactively addressing potential delays, boosting customer trust.

0 % less deviation
Standardized Workflows

Reduction in process deviations

Enforce consistent claim handling by identifying and correcting non-standard process paths, improving predictability and reducing compliance risks.

0 % cost reduction
Reduced Cost Per Claim

Average percentage reduction in operational costs

Optimize resource allocation and eliminate unnecessary activities to significantly decrease the average operational cost associated with processing each claim.

Individual results may vary based on your specific process complexity, data integrity, and operational context. The figures presented illustrate common gains realized through our solutions.

FAQs

Frequently asked questions

Process mining provides a data-driven X-ray of your actual claims journey within Sapiens ClaimsPro. It uncovers hidden bottlenecks, deviations from standard paths, and sources of rework, allowing for precise optimization. This leads to faster resolution times and increased operational efficiency.

You primarily need event log data containing a unique Case ID (e.g., Claim ID), an Activity Name (what action occurred), and a Timestamp (when the action happened). Sapiens ClaimsPro usually stores this in its database, and extracting these three core elements is fundamental for mapping your process.

Expect significant improvements such as reduced claim resolution times, fewer re-submissions, and better adherence to regulatory compliance. Process mining helps optimize resource allocation and can lead to a lower average cost per claim, increasing overall transparency and efficiency.

Extracting data from Sapiens ClaimsPro usually involves standard database queries to access its underlying tables. While initial data cleaning and transformation might be necessary to fit the "Case ID, Activity, Timestamp" format, it's generally a manageable task for someone familiar with SQL or reporting tools.

Yes, process mining excels at identifying non-compliant claim handling paths and deviations from established rules. It visualizes every process instance against defined regulations, allowing you to proactively detect and correct instances where policies are not followed within Sapiens ClaimsPro.

Process mining complements existing reports by providing a dynamic, visual understanding of the flow of work, rather than just static metrics. It answers "why" certain KPIs are observed by showing the actual process variations, offering deeper diagnostic insights beyond traditional dashboards.

After successful data extraction and transformation, initial process models and insights can often be generated within days or a few weeks. The speed depends on data availability and the complexity of the claims process being analyzed.

Basic data analysis skills are beneficial, along with familiarity with data structures, potentially SQL for data extraction. Many modern process mining tools are designed with user-friendly interfaces, minimizing the need for advanced technical expertise for ongoing analysis once data is configured.

Absolutely. By identifying bottlenecks and workload imbalances, process mining clearly shows where resources are over or underutilized in your claims department. This enables data-driven decisions to redistribute tasks, improve staffing levels, and reduce processing delays caused by resource constraints.

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