Case Studies
Improving claims efficiency for Apollo DKV
Situation
The existing claims administration system involved manual handover of
information from the TPA and called for duplication of efforts, and often to
data inconsistency. With the business growing, tracking of claims was
becoming arduous and there was a lack of control over the process.
Client Engagement
Apollo DKV is a joint venture between the Apollo Hospitals Group, a trusted name in healthcare in India, and Deutsche Krankenversicherung (DKV) AG, a leading European health insurer. It provides innovative health and travel insurance solutions at an affordable rate and aims to become the health insurer of choice in India.
Scope
- Current state assessment of ADKV’s claims management, its systems and processes
- System covering individual and group personal accident / domestic travel products
- Benefits to be addressed - accidental death, permanent total disablement, permanent serious disablement, permanent partial disablement and total temporary disablement
Challenges
- Existing policy administration systems did not comprehensively address claims definition requirements
- Claims administration was handled using information provided by the TPA (third-party administrator) responsible for claims management
- Structured and integrated claims tracking for process control was missing
- With business growing, the team size for generating claims MIS was continuously increasing
- Because of the absence of any existing claims system, business requirements had to be visually aided for effective confirmation.
Engagement Approach
- Screen prototypes and questionnaires helped in the analysis of existing claims operations across accident and domestic travel needs.
- Detailed study of needs, existing claims processes and information. Interaction and process walkthrough with users and discussions with function heads.
- Assessment of other system integrations.
- Ready-to-use technical architecture framework from C2L BIZ.
Value Delivered
- Flexible business framework to accommodate future needs such as an enhanced solution for independent claims functionality, and solution to cover other product lines, benefits etc.
- Many process and information integration points identified for improving efficiency.
- Ability to de-centralize claims processing.
- Delivery on time and within the agreed fixed-bid cost quoted upfront.