Case Study: How Integrated Operations-as-a-Service Provides Customer Value

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 property and casualty claims servicing. The new property and casualty 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.

Furthermore, one of the key differentiators for the new division was to set and achieve aggressive service-level agreements (SLAs) with clients. This meant quickly and efficiently assigning claims while keeping caseloads within standards and expediting claims intake and first notice of loss (FNOL) documents. It would also require escalating large claims and performing front-end work, such as file review, policy verification, and fraud investigation to streamline the adjusters’ tasks.

In addition, the TPA sought access to 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 property and casualty team. 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 assumed responsibility for the client’s claims entry—including claims setup, adjuster assignment, creation of claim letters, and others—and assisted their adjusters 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 approach to integrated operations leverages RPA as a tool rather than a standalone solution. This effectively overcomes the limitations of a traditional approach to RPA to create scalable, cost-effective results that benefit customers:

  • Flexibility. Complex workflows, such as claims, typically require an exchange between a human processor and a bot. For example, a ReSource Pro claims processor fills in a claims template that is forwarded to a bot, which automatically updates the claims management system and returns to the processor, who then assigns the claim. Adding a human into the loop takes advantage of automation while reducing the need to update more complex tasks in response to rule changes or other adjustments. At the same time, automating certain processes increases throughput and allows for smoother scaling of services to meet fluctuating customer needs.
  • 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 property and casualty service. Our unique model integrates people, process, and technology and seamlessly blends in automation to deliver scalable output on a complex process with constantly changing workloads. And despite 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.