Claims Integration and Automation Practices of Voluntary Carriers Spotlight™ Report
Cost: $3,500; published 2024
Voluntary claims practices continue to evolve as customers — brokers, employers and employees — place more value on the benefits provided by voluntary products. These key stakeholders expect the claims process to be easy, especially for employees who own multiple voluntary products through the same carrier. The “Claims Integration and Automation Practices of Voluntary Carriers” Spotlight™ Report provides important information for carriers about claims processing and claims integration practices for voluntary products, including:
- Claims automation and adjudication
- Percentage of auto-adjudicated claims
- Claims submission methods
- Claim payment timeframes by product
- Claims integration practices
- Volume of integrated claims
- Impacts of integration
- Concerns, obstacles and future trends
View Table of Contents
1. Executive Summary
A. Report Objectives
B. Methodology
C. Key Findings
D. Recommendations
2. Findings by Carrier
A. Company Data
1. Claim Structure and Organization
B. Claim Filing and Status Capabilities
1. Ways to File a Claim
2. Notification ot Claimants
3. Claims Submission Percentages
4. Variations by Product Line
5. Follow-ups to Claimants for More Information
6. Claims Status Tracking
7. Claims Tracking for Brokers and/or Employers
C. Claims Services, Support & Tracking
1. Dedicated Support/Service for Claims
2. Claim Services for Non-English Speaking Customers
3. Average Standards
4. Claims Satisfaction Surveys
5. Other Performance Measures
D. Claims Automation and Adjudication
1. Artificial Intelligence/Machine Learning Practices
2. Auto-Adjudication Activity and Percentage of Auto-Adjudicated Claims
3. Percent of Claims Auto-Adjudicated by Product
E. Claim Payment Timeframes by Product
1. Average Actual Claim Payment Times for Life Products
2. Average Actual Claim Payment Times for Disability Products
3. Average Actual Claim Payment Times for Accident, Cancer and Critical Illness
4. Average Actual Claim Payment Times for Hospital Indemnity and Wellness Riders
5. Average Actual Claim Payment Times for Dental and Vision Products
F. Claims Processes and Services
1. Express Pay Claims
2. Intuitive Claims Payments
3. Prepayment of Disability Claims
4. Claim Payment Options for Life Products
5. Claims Investigation During Contestable Period
6. Claims Investigation During Pre-Existing Exclusion Period
7. Wellness Claim Processing
8. Employer Verification of Claims
9. Self-Bill Eligibility Requirements
G. Claims Integration Practices
1. Carriers Offering Claims Integration
2. Types of Claims Integration with Medical Data
3. Opt-In Requirement and Process for Medical Claims Integration
4. Accessing Medical Claims Data
5. Types of Medical Plans for Integration
6. Types of Claims Integration with Life and Disability Data
7. Types of Claims Integration with Voluntary Supplemental Health Products
8. Volume of Integrated Claims
9. Loss Ratio Impact Due to Claims Integration
10. Methods Used to Notify Claimant
11. Claims Integration Charge
12. Use of Technology Platform, Outside Systems or Databases for Claims Integration
H. Claims Concerns/Obstacles/Future Trends
1. Key Concerns or Obstacles for Claims Integration and Automation
2. Future Claims Concerns/Obstacles/Trends
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