Quality Assurance for Insurance: Getting Automated Claim Adjudication right, the first time

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The global pandemic not only was a health scare – it also led to a lot of economic distress. While Insurance companies in such times play a critical role in providing a cushion and help organizations manage the risks, they too have been under tremendous pressure. Not only are they subject to the volatile financial markets, they also need to adjust to the new norm – and yet be successful in their venture.

Per a study by Coforge, “The Insurance carriers have lost roughly 48% of their market value since the crisis commenced; with life & health insurance carriers particularly hit hard with average drops of 58%. The cost of COVID-19 testing and treatment is likely to squeeze U.S. health insurers’ profits, which could lead to higher premiums in 2021.”

Changing times and customer needs require technology adoption

The business imperatives and the changing customer needs have made it critical for insurers to embrace disruptive technologies such as Blockchain, AI and IoT. Digital transformation is no longer a choice for them, and one must use these technologies across the value chain for enhanced brand differentiation and higher profitability.

Most of the QA programs often take a back seat when choices are made for the future course of technology transformation. Organizations that show agility and a commitment to constantly unlearn and learn from the experience will reap benefits as they tread along the digital transformation journey. Those who decide to bide their time and remain cautious will be at a risk of being left behind.

With the pandemic spurring on the need for digitalization, accelerating the adoption of automation has become critical in the role of the claim handling and adjudication process, a vital aspect of insurance companies.

Quality Assured Automation of Claim Adjudication

A bad claims experience can lead to almost 84% of the insured and proposers change their insurer. This is an alarming enough rate to emphasize the importance of automation and customer satisfaction during the claim adjudication process.

Not only does a traditional claims processing take many days due to manual intervention and a lot of paperwork, there’s also the challenge of even small errors such as a misspelled patient name that can cause a claim to be rejected.

How can insurers adapt to their customer demands whose needs, knowledge and expectations have expanded exponentially? The customers naturally want their problems to be addressed fast, and an organization that can achieve this is going to put itself in the driver’s seat.

In an age where customers voice is a critical mode of improving – or spoiling one’s reputation, insurers must understand that there is a need to adapt to the new demands in the digital era. It is imperative, thus, that the claims are submitted electronically where the software can help prevent errors before it is submitted for payment.

This is where automated claim adjudication comes into play.

Quality Assurance is key for Insurance companies to gain the trust of their customers, and to run their business seamlessly without any hindrance. Getting the automated claim adjudication right for the first time is what the insurance companies should vouch for.

To automate any segment in the Insurance sector, organizations need to emphasize on 4 major factors:

  • Understanding the end-to-end flow
  • Writing precise business test case scenarios
  • Creating the right automation framework suite and
  • Assessing the testing state of the automated software

Creation of an end-to-end digitization of a claims journey, that implements features such as digital claims status tracking and automated claims segmentation will work wonders for insurance companies.

With continuous integration of automation suites, one can achieve more visibility in the test coverage, thus drastically reducing the test efforts. All the positive and negative scenarios surrounding the claim adjudication workflow must be covered in the automated framework so as to ensure 100% accuracy.

Benefits of Technology Adoption in the Insurance world

With the COVID-19 outbreak, we have been observing the multiple changes that have swept across the insurance industry.

By using sophisticated technologies as Robotic Process Automation (RPA), insurers can drastically reduce the manual efforts by up to 90% and improve their transaction capabilities by up to 50%.

The potential of the distributed ledger technology (Blockchain) to foster 360-degree transparency, accountability and robust data security is huge. Detecting and managing fraudulent claims could become very easy with the use of Blockchain. Smart Contracts is a tangible application of Blockchain that can be used by insurers and related stakeholders to swiftly access and update relevant data across claim evidence, 3rd party review reports and other relevant reports for robust risk mitigation.

Additionally, in the coming future, insurance companies will need to harness the best of Artificial Intelligence and human intelligence to lead in the market. Per McKinsey, “Insurers with pure-play digital business models, such as Lemonade in the United States, Youse in Latin America, or Nexible in Europe—are using digital applications such as chatbots to turn the process of buying a policy or filing a claim into a fast, simple, and satisfying experience.

AI can thus help Insurance organizations become more customer-centric and digitally enabled, so as to provide the best possible “customer experience, efficiency, and effectiveness.” Proper use of AI coupled with Big Data Analytics can help insurers analyse and make sense of the tonnes of data available to provide maximum customer delight.

How can Cigniti help you?

Cigniti supports global insurers in their digital transformation journey & helps them deliver improved customer experience & gain competitive advantage. Our testing services portfolio and matchless track record prove us as a trusted advisor and preferred technology partner for the Insurance clients. To transform your legacy processes with our specialized insurance software testing services, schedule a discussion with us today.

Cigniti’s proprietary workflow technology and automated quality processes help reduce the chances of erroring out to zero percent. While the world is getting adjusted to the COVID-19 norm, Cigniti’s specialized insurance software testing services are bound to transform your legacy processes. Our customized services and Insurance Testing Centre of Excellence range across Life Insurance (Life, Annuity, and Pension), Property & Casualty (P&C), Auto, & Reinsurance segments.

Cigniti’s Testing CoE for Insurance also comprises of prebuilt test accelerators, enterprise-wide tool-agnostic test automation framework, premium checker – premium rating engine, our next-generation IP (BlueSwan) & reusable test repositories that ensure your apps/systems run seamlessly by ensuring efficient back-office operations.

Armed with industry-recognized certifications in Life and Non-Life insurance domains, our certified domain experts (with recognized certifications such as LOMA, ANSI, CPCU) have experience in regulatory testing specific to various geographies including State-based Insurance Regulatory System, Federal Regulation of Insurance, National Association of Insurance Commissioners (NAIC), ABI, IRDA, IRTA, & Unclaimed Property Act (UPA).

To transform your legacy processes with our specialized insurance software testing services, schedule a discussion with us today.


  • Cigniti Technologies

    Cigniti is the world’s leading AI & IP-led Digital Assurance and Digital Engineering services company with offices in India, the USA, Canada, the UK, the UAE, Australia, South Africa, the Czech Republic, and Singapore. We help companies accelerate their digital transformation journey across various stages of digital adoption and help them achieve market leadership.

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