Case Study: Improving Business Performance with Insurance Operations-as-a-Service

Getting a new division up and running quickly can be a challenge, especially in today’s highly competitive talent market. Here’s how a leading third-party claims administrator offering workers’ compensation, managed care, and program business solutions was able to drive success with the help of ReSource Pro.

Challenge: Achieving Growth in A New Division While Maintaining Quality and SLAs

The TPA sought to expand its offerings by adding P&C claims servicing. The new P&C team wanted to focus on growth, creating new value-added programs, and servicing its carrier clients. However, the company lacked the time and resources to develop a fully-fledged administrative infrastructure as well as recruit and train back-office talent.

As an extra challenge, the new division was tasked with setting and achieving aggressive service-level agreements (SLAs) with clients. This meant expediting claims intake and FNOL documents, assigning claims quickly and efficiently, all while keeping caseloads reasonable. Large claims also needed to be expedited, and extensive front-end work, like file review and policy verification, was required.

In addition, the TPA needed scalable resources to meet its ambitious growth goals of reaching more than 20% growth for new divisions within five years.

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Solution: Integrated Operations-as-a-Service

After weighing its options, the TPA chose to engage with ReSource Pro to support its P&C business operations. The ReSource Pro team immediately set about easing the workload of the client’s adjusters and managers by assigning a ReSource Pro team in India to handle all claims adjuster follow-ups and FNOLs, effectively transforming the TPA into a 24-hour operation and eliminating the need for an internal team to perform these tasks. The ReSource Pro team also took on client’s claims entry—including setup, adjuster assignment, and creation of claim letters—and assisted their in gathering data for claims investigations, including ISO and police reports as well as plate/VIN numbers.

In just three months, the ReSource Pro team was running at 100% production, providing additional operational stability to the client’s new division and allowing their team to focus on strategic growth initiatives.

Resource Pro’s operations services use robotic process automation (RPA) as a tool, instead of an all-in-one solution, which tends to highlight the limitations of RPA. When used alongside human expertise, RPA is a powerful automation solution

  • Flexibility. A human-in-the-loop automation model keeps people at the center of the equation, while bots take care of tedious and time-consuming tasks. In other words, it’s the best of both worlds: increased throughput combined with responsive, human intuition.
  • Industry knowledge. Our automation developers all have previous experience as insurance processors and draw on deep industry knowledge to develop, maintain, and update bots.
  • Automation-aware operators. Our service delivery teams have training and experience in process automation so that they can work closely with the development team to create new bots and update those that can be improved.
  • Process optimization and standardization. Beyond automation, our service delivery teams work with standardized processes that are continually optimized for efficiency. Standardizing processes at the human and bot level makes automation more efficient and effective.

The Impact: Increased Focus on Strategic Work

The TPA benefited from a quick turnaround time and a high quality, cost-effective solution that freed up capacity and resources for more strategic work. With ReSource Pro’s support, the client exceeded their growth goals for their new P&C offering. Our unique model integrates technology like RPA with people and process, for an efficient and responsive workflow perfectly tailored to dynamic workloads. Despite the the challenges of rapid growth, including a 5X+ staff increase, the client saw improved team morale, as adjusters could focus on servicing large claims, improving service, and other key items that needed their attention.

The impact included:

  • Great claims experience for the TPA’s clients
  • Met FNOL SLA of less than 24 hours on a continuous basis
  • Claims setup time reduced by 39% to 21.61 minutes
  • Claims assignment time reduced by 31% to 8.63 minutes
  • Launched multiple new programs
  • Attracted new carrier partners

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Visit our business process management and solutions pages to learn how ReSource Pro can support your insurance organization. Explore our other case studies to read more about the impact we’ve achieved for our clients.