8 Things You Should Know Before Choosing a Claims Processing Company

By Brown Walsh – Processing large volumes of data, be it in physical or digital form, is the bane of every organization’s existence. It consumes a lot of time that could otherwise be used on the core competencies. If you’re a small-time entrepreneur looking to make it large, then the tedious nature of manual data management can severely hamper your progress. One of the areas where this is particularly true is claims processing.

Despite the advent of automation helping ease the process, insurance companies have to put up with a lot of data (and related redundant activities) to process a claim successfully. A simpler solution is to outsource this task to an experienced claims processing company. Their experts can take the burden of mundane tasks off your shoulders and get everything done with more accuracy and speed. They are a valuable asset to any business looking for simplified claims processing without investing much money or many resources.

But it’s all possible only if you select the right outsourcing agency. Find out how to secure the best insurance claims processing service provider for your business.

Read: Understanding The Car Accident Insurance Claims Process

Things to Evaluate about a Potential Claims Processing Company

Past Performance

The saying goes that history repeats itself, and when it comes to business service providers, that is often the case. Since claims processing involves a lot of repetitive tasks, it is easy for a claims processor to fall into a routine and continue to repeat some mistakes. Thus, looking at a company’s past performance can tell a lot about its future, which you can use as an evaluation criterion for your benefit.

Take a look at your potential claims processor’s website to learn about their past. The Testimonials and Case Studies sections are a good place to check how well they completed their previous projects. Another good source to evaluate their history is their previous partners. See if you can contact any of their previous customers, and if so, ask them about their experience partnering with your potential claims processor on their project.

Ratings and review portals also give a good look into this factor. A Google search about the company will give you ratings and customer feedback quickly. Dedicated B2B review sites like Clutch can deliver on those as well. The bonus is that these royals have experts reviewing businesses based on a host of criteria. You can also find testimonials about those businesses from previous partners there.

Evaluating their past performance ultimately tells you about their suitability for your claim processing requirements on multiple factors.

Read: What Type of Insurance Should You Consider for Your Small Business

Cost Structure

One of the biggest benefits of outsourcing is cost savings. But that won’t be the case if your potential claims processor doesn’t fit your budget. When it comes to the cost evaluation of a potential partner, it is about striking a balance between quality and price. While those charging higher rates tend to offer better quality, the same may not always be true.

You may also tend to choose a quality claims processor charging very high rates but with little ROI difference between them and another doing the same at a lower cost. Hence, scrutiny is necessary for this step.

Start by having a budget in place so that you get a reference for comparison. Then, take a look at the pricing structure available on their website or through other means. Check to see if that pricing structure is worth the type and number of services they offer for it. See if you can mix and match those services in packages that will suit your requirements better. Combine this knowledge with their past performance to better evaluate their charges.

Also, ask a representative about this and how they wish to get paid. Determine if an hourly, monthly, or yearly structure works for you or if you’d like to go with an upfront charge. Compare their prices to other agencies and sites that provide such information so that you can have a potential bargaining point to lower your bills.

Industry Niche

Not all claims processors are created equal, with some choosing to function in one or more specific industry sectors. A medical claims processing company, for example, will focus solely on that and not take up processing for other forms of insurance. Some others offer claims processing for multiple niches that you could opt for.

The key factor to check in the latter case is if they can deliver the same quality on each type of claim they process, and that it is up to the industry standard. If so, then you can go ahead with outsourcing to them since they tend to be cheaper than those focussing solely on one or a few niches.

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Often overlooked, the location of operation of a claims processing company is a crucial factor to evaluate. Outsourcing to a developing company that is based in a developing country gives you a massive cost-saving advantage due to the currency exchange rates difference. Places like India provide performance at a low cost without any drop in quality compared to the industry standard.

If your claims processing outsourcing agency has offices in multiple locations around the world, then it’s even better. That is because different countries have different laws applicable to the process and associated financial practices. Local experts tend to have a better grip on those regulations, helping you avoid compliance mistakes while maintaining the speed and quality of claims processing you require. This is especially useful for multinationals and small-scale companies looking to scale.

Quality of Personnel

A company’s workforce determines the quality of its outputs. Hence, you should evaluate the personnel of your potential claims processing hires to check if they can deliver on your project requirements. The past performance of the potential hire can act as a lighthouse in pointing to the quality of the personnel present at the outsourcing agency.

You could also conduct a personal evaluation of their qualifications by asking for the same from the company’s representative. Check if their professional experience levels and academic background are in line with the kind of project you are outsourcing. For example, it helps immensely if the processing experts are from a medical background if you want to outsource your medical insurance claims. That way, there is little room for delays, confusion, and errors.

Another thing to note is the kind of training and hiring protocol your claims processing company of choice has adopted. Regular training ensures that the personnel is up to speed on all the latest developments in the field, helping you maintain a competitive edge. A good hiring practice means they can replace quitting personnel quickly without a change in the quality and speed of the output.

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Technology Used

Much of any processing work done today occurs using computers. Hence, your potential hire should use the latest technology for the work. Ask the representative about the equipment they have in place and about the software they are using. It helps to gain some knowledge about this before your inquiry. Check how regularly they update their equipment and software and the cloud service provider they are using since compatibility is necessary here.

Data Protection Practices

Insurance comes with many data privacy regulations that should be followed without problems while processing claims. The medical field, in particular, is chock-full of them, like HIPAA, to ensure that a patient’s data remains confidential. Some businesses would also like to keep some incidents under wraps to protect their brand reputation and have insurance processed invisibly. A claims processing agency should oblige these data privacy and security requirements.

Ask about the data security and privacy practices your potential claims processor has in place for the purpose. Check to see if they are in line with the best in the industry. Also, note their troubleshooting protocols so that any eventuality can be handled with little to no disruption to work and your brand value. Their data protection practices should include cloud operations as well.

Communication Practices

Outsourcing for insurance claims processing necessitates constant and clear communications between concerned parties. Otherwise, the chances of deviation from the project’s requirements increases, leading to unwanted adverse consequences. You should confirm how your potential claim processor intends to communicate with you during the process.

You should know about the schedule for regular update meets and the technical tools they’ll use to communicate with you during the process. Establish an information exchange policy internally before outsourcing so that you know exactly what information to share with them and when.

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Insurance is a vital necessity to lead a good life and a good business too. Thus, the need for insurance claims processing will only go up with time as demand increases. Opting to outsource insurance claim processing services will not only save you time and money but also provide you with a competitive edge in the market. However, if you find yourself questioning the utility of an external service provider, start with something smaller (like data entry or form processing) to test them.

As long as you get the right partner to support your business in this endeavor, you can expect to make gains in your business consistently.


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