Making the Invisible, Visible: The True Path to Technology driven Operational Efficiency in Health Insurance Claims Processing

The need for a human-in-the-loop to validate and remediate digitization is critical. It serves as a great way to validate data and ensure quality for upstream applications to consume. Without human involvement, we risk the authenticity of the data and thus reduced trust.

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In the complex world of health insurance claims, the pursuit of operational efficiency is paramount. Technology offers powerful tools to streamline processes, reduce errors, and accelerate turnaround times. However, the promise of "Achieving operational efficiency using technology" is not a destination reached on day one of an implementation. Instead, it's a journey of continuous improvement, fueled by the ability to make previously invisible inefficiencies, visible.

Why Operational Efficiency Isn't a "Day One" Deliverable?

Many organizations invest in new technologies expecting an immediate, transformative impact. This is even more difficult when it comes to a problem like claims processing. While initial improvements are often seen, true, deepseated operational efficiency is rarely an instant outcome. Here's why:

Baseline Establishment: New systems and technologies first need to operate within the existing environment to gather data and establish a performance baseline. This initial phase is crucial for understanding the current state, not the optimized state.

Gathering data is a time-consuming activity, not years but definitely weeks and in some cases months. It is defined by the amount of data that gets generated every day for machine learning systems to hone themselves.

The primary outcome is to ensure every day activities are not affected and the new system is able to outperform the previous benchmarks consistently.