Claims Processing

ValueLabs provides a gamut of services for insurance claims processing. Through our claims processing, we offer quality customer experience by increasing operational efficiency and drastically cutting upon the overall response time. We help insurance providers minimize costs and improve their productivity while building successful and long-lasting customer relationships.

Claims processing has evolved as both – the single largest business cost and one of the most visible customer experiences. Improving the claims experience has thereby become critical for businesses, helping them achieve both; a new level of sustained operational efficiency and customer satisfaction.

As a part of our KPO services, we offer claims processing for insurance providers with the aim to enhance customer experience by dramatically improving the overall response time. In addition to building customer relationships, we help insurance providers reduce costs through improved operational efficiency. As a case in point, we have processed over 1 million claims for a leading health management services provider in USA, while improving productivity (approx. 17.5 claims per hour) and reducing cost per claim considerably (approx. $ 0.60 per claim).

With our technical competency and domain experience, we provide the following claims processing services:

  • Pre-adjudication
  • Adjudication
  • Pricing
  • Pend resolution and adjudication system response
  • Development of workflows for planning
  • Tracking manual interventions

We have significant expertise in:

  • Understanding & analyzing the requirements and / or request
  • Processing HC, DC, CRA & VR claims
  • Processing based on regular updates client wise on rules / procedures
  • Qualifying event data sheets (QEDS, QEN, PRELIM)
  • Processing enrolment forms (election agreements) & verification of enrolment accuracy
  • Processing items in document imaging system for different document types COR, EF, EWC by enrolling, adding / dropping dependence, adding / dropping coverage & address changes
  • Working on data exception, end of subsidy, coverage, missing rate, audit, QEN, paid thru dates, retiree, involuntary, termination, eligibility & carrier reports
  • Tracking of all performance, production and quality based reports

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