Claims Adjudication

Deep understanding of the various insurance claim processing business by the vast number of BPO's in India has resulted in matured process flows, highly dependable claims adjudication system and fully scalable total solutions in processing and adjudicating high volume insurance claims.

• The claims adjudication process involves checking whether the individual is covered by an active insurance policy and then checking the information against the insurance companies master database.
• Identifying duplicate claims is another function undertaken by the BPO's .The next step involves tracking the members eligibility, history, provider assignments, and coordination of benefits and finally adjudicating whether or not the claim is a valid claim.
• Next step involves collection of all the data required for processing the claims and then the BPO determines adjudication based on user defined criteria. All the data collected goes through adjudicating engine for thousands of validation edits for data quality, data consistency, format validity, HIPAA compliance etc.
• Lastly, the final output of adjudicated claims is then sent over to the insurance provider to pay or reject the claim. Then a detailed report on all the claims is compiled by the BPO which are adjudicated as per the requirements of its clients on a daily basis.

The various insurance services provided by the BPO's in India result in increased administrative efficiency, reduced costs, quick settlement of claim payments and a true return on investment.