Context
Our client, a leading commercial auto claims and workers' compensation management company, experienced substantial delays with respect to claim adjudications and payments. The call center representatives (CCRs) processed and managed eight different document types submitted by claimants, including driver’s licenses, vehicle registration, policy information, police or accident reports, invoices/estimates/proof of payments related to repair, towing, storage and appraisals, and bank details for ACH or direct deposit.
CCRs assisted claimants with gathering information for their claim, creating claims in the Salesforce Claim Management System, issuing claim numbers, and advising claimants what additional documentation they needed to gather and how to fax those documents. The manual process of downloading, reviewing, tagging, indexing, and uploading documents to the corresponding claim accounts was time consuming and prone to errors. Also, claims would be transferred to an adjuster only when all required documentation had been received, reviewed, and uploaded.
Problem
Document management at the company was heavily dependent on manual work performed by call center representatives. When claimants called to start their claims process, the CCRs collected information, created claim records in Salesforce, and then spent considerable time to get faxed documents, review content, apply metadata, index files, and then upload materials to the correct claim accounts.
These time-consuming activities created bottlenecks throughout the claims pipeline. The specific challenges experienced by the client included:
- A total of 10 full-time staff members worked exclusively on performing document-related tasks
- Claim preparation would consume 25 minutes per claim, with 200 claims processed each day
- On average, each claim was placed into a "holding" status for 7 days prior to being transferred to an adjuster
- CCRs spent considerable amount of time in pursuit of claimants who missed or did not submit documentation needed for their claims
- Files submitted to CCR were sometime sent to incorrect accounts or mislabeled despite successful receipt
- Inbound files locally stored on CCR machines caused compliance risks and exposed the company to potential data breaches
Solution
Cloud Maven, Inc implemented Secure File Transport (SFT) solution to transform the way documents were collected and processed. It took out all of the manual processes that consumed the majority of CCR's time and added intelligent automation to every aspect of the document's lifecycle.
With this solution, what once had been a multi-system, manual, and weeks long document processing task was now an automated document collection process initiated directly from Salesforce claim record. Some key enhancements included:
- One-Click Document Collection: CCRs can now begin the document collection process by creating a document upload envelope through one click within the Claim Record
- Secure Digital Document Upload: Claimants are provided with a direct link via e-mail or SMS to upload required documents for each claim type
- Automated Document Classification: Documents are automatically assigned and tagged to respective document types based on intelligent envelope configuration
- AI-Powered Document Routing: Using Optical Character Recognition (OCR) and AI along with assigning metadata to each submitted document, ensures correct routing to the applicable claim accounts
- Automated Claim Progression: Claims automatically move to the adjuster review upon receipt of all documents, with notifications sent to both the adjuster and claimant
- Real-Time Image Validation: Claim images are validated in real time using image authentication technology, such as Truepic, to verify their authenticity and integrity. This helps insurers identify potentially manipulated or fraudulent images early, reduce manual review, and expedite the auto claims process.
Together, these capabilities enable faster, more secure claim processing while reducing manual effort, errors, fraud risk, and compliance exposure.
Implementation
The deployment was planned to ensure that there would be no disruption in the workflow when transitioning from manual to automated process. The team at Cloud Maven, Inc worked closely with the client to configure document upload templates, establish notification protocols, and train CCR staff on the new streamlined process.
Results
The deployment of Secure File Transport solution has changed the way our client collects documents and prepares claims. It moved the organization away from a labor-intensive manual process to automated document handling that produced measurable improvements across all operational metrics.
Key improvements include:
- Reduction in dedicated FTEs from 10 to 2 staff members, resulting in approximately $400,000 annual cost savings
- Time spent on preparing claims was decreased from 25 minutes per claim to five minutes per claim by removing multiple manual steps
- Claims now move to adjuster review in 1 day compared to the previous 7-day cycle, achieving an 86% reduction in preparation turnaround time
- Customer status inquiring dropped by 90% due to automated triggers and dashboard visibility
- OCR-enabled document classification eliminated routing errors and mis-categorization issues
- All documents flow to the corresponding claim accounts with end-to-end encryption and no files are stored locally on devices, ensuring compliance with data protection requirements
