How insurance companies can improve the accuracy and productivity of their manual claims processing operations. With Enkata, claims payers get visibility and insight into how their claims processors are working. They can identify and remove the causes of errors and lost productivity. They can ensure process compliance. They can determine best practices for claims payers.

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Insight. Action. Results.
Improving Claims Processing
Using Enkata to Improve Manual
Claims Processing
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> Productivity Isn’t Where It Needs to Be
> Skill and training gaps
> Work habits
> Process and technology issues
> Surveys show manually adjudicated claims cost more than $6 each
> Accuracy Isn’t Where It Needs to Be
> Error rates on poor processors may be >10%
> Underpayments = complaints and rework
> Overpayments = lost money, and few are caught
Claims Payers Have Two Problems

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> Managers have limited visibility into how claims
processors work
> What their work habits are
> Where they are struggling
> If targets are set correctly
> Employees have limited visibility into how to work
> What is the best process for a claim type
> What are the tricks the best people use to be productive
> “Am I doing this right?”
The Root of Problem: Lack of Visibility

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> “Managing by Metrics” Isn’t Managing
> “Claims per Hour” doesn’t tell you if they are following the right
process
> Just knowing the metric gives no insight into how to improve
performance.
> If metrics are compared to past average instead of potential
performance, you’re capping your potential at average.
High Level Metrics Don’t Help

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> “At a Glance” understanding of claims processors
> How they work
> What drives quality and productivity
> What specific actions can help them improve
> Process Analytics for Claims Payers
> What steps lead to higher quality?
> Which steps are people skipping?
> Have the best people figured out a better way to do things?
> What mistakes are most common?
Enkata’s Solution Starts with Visibility

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> More Granular Data
> Views from Month-to-Month performance down to the specific
steps taken to process every single claim
> Easiest to Understand
> At-a-Glance reports tell managers and processors everything
they need to know to understand performance
> Flexible Analytics for Data Scientists
> Enkata captures and creates data about claims processing, and
then provides a free form analytics environment that lets data
scientists explore the data, find deep insights, and understand
everything about manual claims processing
Enkata’s Solution for Claims Payers is
Completely Different

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> Identify and Eliminate the Behaviors that Lead to Errors
> Enkata delivers understanding into error prone workplace
behaviors including target shooting, multi-tasking, thrashing and
excess pending
> Identify and Enforce Process
> Processors may be skipping the annoying steps that keep
accuracy high. With Enkata, you can see who is taking short
cuts, and tie that to the accuracy issues you’re trying to fix.
> Identify Exactly Where People Need Help
> Even generally good processors may have issues or make
mistakes with certain types of claims. With the visibility delivered
by Enkata, managers can see where people struggle and need
extra coaching
Enkata Improves Claims Accuracy

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> Eliminate the behaviors that lower productivity
> Excess email and IM, idle time and black list internet, and other
behaviors that detract from production
> Eliminate the Problems that Hold People Back
> Employee skill gaps, technical bottlenecks, incorrect training
> Set Targets Based on Potential, Not Historical
> Most claims payers set productivity targets based on productivity
levels they’ve seen in the past, not on what an individual should
be expected to produce in a time period.
> Replicate the Best Practices of Top Performers Across
the Group
Enkata Improves Claims Payer Productivity

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> Map Different Practices to Understand How Different
Groups of Workers Perform
> Discover best practices
> Have data based discussions about claims processing
> Track the Key Steps Required for Accuracy
> Who is skipping them?
> Who is doing them out of order?
> What is the impact of non-compliance?
Enkata Improves Processing Compliance

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