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Optimizing Medical Claim Processing

Although U.S. property and casualty insurers pay approximately $50 billion per year in medical claims, carriers are a long way from reaching peak efficiencies in analyzing and processing those claims.

By Michael A. Costonis | Updated on March 04, 2010
Although U.S. property and casualty insurers pay approximately $50 billion per year in medical claims, carriers are a long way from reaching peak efficiencies in analyzing and processing those claims. Carriers realize that employing advanced analytics—using structured data gathered from medical records—would have immediate and direct benefits in a number of areas, including indemnity accuracy; recovery identification and capture; and fraud detection and prevention.

The scarcity of key skills—along with the difficulty of scaling up already complex processing operations—prevents carriers from taking full advantage of this opportunity.

We have explored these issues in depth. In July and August of 2009, Accenture worked with an independent market research firm to conduct interviews with 30 senior claim executives—either the head of claims or the equivalent—at major U.S. property and casualty insurers. These individuals possess keen insight about their companies’ overall performance in terms of injury claim management. They are also intimately familiar with the types and volumes of claims managed and the technologies currently in use.

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