5 Critical Areas of Core Administration an Agile Insurance Solution Can Help With

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5 Critical Areas of Core Administration an Agile Insurance Solution Can Help With

The health insurance industry is currently undergoing a period of rapid change, spurred by global health crises such as the COVID-19 pandemic, the increasing ubiquity of digital technologies, new advancements in healthcare, and changing consumer expectations, among other factors. Healthcare payers today face an unprecedented level of pressure to roll out new products and services, comply with ever-evolving regulatory mandates, and accommodate alternative care models such as telemedicine and virtual consultations.

To meet these expectations and retain their competitive edge, healthcare payers must invest in a robust health insurance solution regardless of their organization’s size. Large companies will naturally have the capital to invest in state-of-the-art software and any additional resources required to run it optimally. Small- and mid-sized organizations, on the other hand, can keep up by exploring accessible insurance solutions that make business agility and flexibility their highest priority. In particular, an interoperable cloud-based platform will give smaller payers the nimbleness required to navigate constantly shifting market conditions with ease.

Maximum flexibility is necessary for healthcare payers and providers to keep functioning at their best in today’s increasingly volatile business environment. Here are five core administrative capabilities that an agile insurance solution can support:

Policy Administration

Today’s consumers appreciate innovation from the service providers they work with in basically every area of life, and health insurance organizations are no exception. It’s no longer enough to provide a small array of tried-and-tested products and services. Insurers must also work to develop new offerings and send them to market at least as fast as, if not faster than, competing organizations. Furthermore, members must be able to view these products, compare them to existing ones, and understand the unique benefits each one offers.

Cloud-based insurance platforms are instrumental to decreasing time to market and achieving this accelerated rollout process. The best insurance solutions will also support faster and more efficient enrollment using tools like digital ID cards. These functions enable members to switch over to new policies and begin enjoying their benefits immediately.

Billing, Payments, and General Revenue Management

While insurers can get members on the hook by providing well-developed products that cater to their unique needs, they may still lose member patronage if their billing processes are too lengthy, inconvenient, or difficult to understand. Modern health insurance solutions simplify and streamline the billing process with functions like scalable, dynamic pricing and support for a wide range of payment options. This greater agility makes it easier for health plans to bill providers quickly and accurately and collect payments promptly.

Efficient billing and payment systems pave the way for smoother revenue management throughout the entire organization. Insurers will be able to monitor cash flow across the entire organization and get a clear picture of customer demands, behaviors, and needs. This critical perspective will, in turn, enable insurers to further optimize their current offerings and maximize profits.

Claims Adjudication and Processing

Claims processing is one of the most expensive, labor-intensive, and time-consuming functions insurance companies perform as part of their regular operations. Companies using legacy technology typically spread out claims processing functions across several different systems, often involving the participation of multiple teams from across the business and from different health providers. This fragmented approach can compromise the quality of adjudications and hinder the timely delivery of claims decisions, setbacks that lead, in turn, to diminished member satisfaction and poor client experiences overall.

Fortunately, a quality health insurance solution will be more than capable of accelerating claims processing for insurers. This is done primarily by using artificial intelligence and machine learning tools to automate most, if not all, of the organization’s claims processing functions. Wide-scale process automation enables insurers to process and adjudicate claims in real time rather than in large batches. Automation also helps reduce labor costs and the likelihood of potentially costly human error incidents for all claims.

Data Security

As the widespread adoption of digital technologies become the norm across every industry, regulations to ensure data privacy and security will also grow ever stricter. Healthcare payers today must comply with a multitude of privacy regulations, and they must also anticipate the possibility that regulators will alter or add to these mandates if the need arises. Contemporary insurance software deploys insurers’ most vital applications to the cloud with the high level of data protection and security that regulators require. The best programs will also be able to scan for and incorporate new compliance requirements in real time.

Supply Chain Management and Financials

Just as insurance members need timely and accurate information on the status of their claims, insurers also benefit from a real-time view of their business operations across the board. They should thus invest in solutions that provide complete electronic record processing at every stage in the claims cycle, from tracking to reporting to auditing. With these tools at their disposal, insurers can track workflows and view operational metrics on a monthly, weekly, and even daily basis.

While navigating the current health insurance landscape is not without its challenges, insurers that embrace the need to adapt have the best chances of thriving in their new environment. Flexible, modern software solutions will give health insurance organizations the agility they need to navigate changes in the market and deliver consistently good member experiences.

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