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Business Rules for Claims Processing

For many carriers, the task of processing claims consistently and in accordance with new programs has become complex and daunting for both their adjusters and the IT organizations that support them.

By Hans Witt | Updated on March 02, 2007

For many carriers, the task of processing claims consistently and in accordance with new programs has become complex and daunting for both their adjusters and the IT organizations that support them. The rules governing critical claim-handling processes are often cumbersome and managed manually by professional staff.

In those instances where rules are automated, usually they are implicit within custom code scattered across multiple applications. Implicit business rules and policies prevent organizations from achieving agility since even simple claim-processing rule changes to a system can take weeks or even months. The lack of a centralized, explicit, and auditable rule repository eventually will result in inconsistent claim handling and outcomes across the company. Faced with regulatory compliance issues, this can lead to company fines and, worse, the loss of an unhappy customer to the competition.

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