How an insurance company can automate claim processes

A cloud-based, process-driven integrated solution to optimize and enhance both the client and the agent experience

The objective of this case study is to demonstrate the interaction between an extranet client portal and the management of requests that can be created with the WorkflowGen Business Process Management workflow solution, along with the benefits of this type of integration.

The use case presented here is of an insurance company that provides its individual and enterprise clients with a secure customized web portal that lets them consult information on their contracts and submit dematerialized medical care reimbursement requests.

The client web portal is an extranet site independent of the request management platform (WorkflowGen, in this case) that can be hosted on an intranet or in a private cloud.

WorkflowGen is also used to handle the insurance company’s internal administrative processes as well as those closely related to its business, including client relations and contract management.

Use case scenario

Once logged in to their secure portal, clients can initiate a reimbursement request for medical expenses.

A web form (unconnected to the WorkflowGen platform) serves to support the client’s entry of the list of medications and fees.

The client can then submit the request. A system action will then be launched that creates a new request in WorkflowGen and automatically assigns a team action to do to users in the Claims Department.

The Claims Department user will be notified by email that a new reimbursement request has been initiated; they can launch the action from within the notification email or by connecting to their WorkflowGen user portal.

Once the action has been launched, a form created with WorkflowGen’s integrated form designer will be displayed onscreen, with the client’s information and details on the request as submitted via the extranet automatically filled in.

The reimbursement request then follows its course based on the workflow and the rules defined during the process design; decisions, verifications, modification requests, and payments can be performed by process actors (Claims Department, Call Center, Managers, Administration).

The client can consult the state of their request in real time at any point during its processing via the extranet portal.

Insurance company secure client portal

Medical claim form captured via the secure client portal

Medical claim workflow designed with WorkflowGen

Claim form dynamically generated by WorkflowGen

Benefits

  • Extranet used as a secure front-end for data entry and digitization of client request management with automated workflows.
  • Boost business web application development by leveraging a BPM workflow platform and by rapidly defining processes with a “low-code” approach.
  • Process and data flow coordination via web services and webhooks.
  • Clients and internal teams benefit from real-time follow-ups and better visibility of requests and associated activities.

Discover more epic real-life examples of business process automation from organizations around the world.