Insurance Process Improvement & Digital Transformation Case Study
Situation
A rapidly growing insurance company faced operational inefficiencies, declining customer satisfaction, and process inconsistencies due to multiple acquisitions. Manual workflows, lack of reporting, and backlog issues negatively impacted the company’s brand and increased customer complaints.
This case study highlights two key challenges:
Claims Adjudication – Manual, inconsistent processes created significant backlogs, delaying claim processing by multiple days.
Unidentified Deductible Payments – Customer payments arrived without proper identification, requiring manual research and resolution, increasing delays and call volumes.
Task
My team was tasked with assessing, optimizing, and digitizing both processes. The company required:
Standardized digital workflows to improve efficiency.
Real-time reporting & analytics for better decision-making.
Automated solutions to enhance accuracy and reduce manual workload.
Actions Taken
Conducted process analysis with frontline teams to identify inefficiencies and pain points.
Redesigned workflows and operating models for both claims adjudication and deductible payment resolution.
Developed a business case with ROI projections, securing C-suite approval and funding.
Implemented digital workflow automation, optimizing claims processing and payment reconciliation.
Managed deployment, training, and adoption strategies to ensure a smooth transition.
Results
Claims adjudication cycle time reduced from 72 hours to same-day processing (an 89% productivity gain).
Backlog of 5,000 unidentified deductible payments reduced by 95%, improving customer satisfaction.
Call Center Efficiency Improved:
Unidentified payment-related calls nearly eliminated.
Average handle time (AHT) reduced by 45 seconds, decreasing operational strain.
Management reporting and process analytics significantly improved, enabling proactive team management.
Data quality and security enhanced, improving compliance with industry regulations.
Key Takeaways & Lessons Learned
Technology adoption takes time – Expect a 2-3 week learning curve before realizing measurable results when introducing automation and digital solutions.
Engage directly with end users – Building trust with frontline employees fosters valuable insights, smoother adoption, and stronger buy-in for process changes.
