Call Center for
Claims Processing

Processing insurance or healthcare claims is a complex task, from gathering documentation to verifying policy information to making adjustments. If you deal with claims processing in any capacity, you understand the importance of managing these tasks quickly to ensure that all parties can move forward with providing care or making repairs. By working with a BPO call center that specializes in case handling, you can forego the lengthy claims management process entirely and reinvest that time and energy right back into your business.

Business process outsourcing (BPO) call centers are companies that handle back-office and administrative tasks, such as case handling, on behalf of their clients. They’ll communicate with insurers, payers, adjusters, and everyone else involved in the claims management process.

BPO call centers have intricate procedures in place to manage information from anyone who needs to make a claim, handling the entire process. If your customers have questions, the call center agents will be available 24/7 to answer questions and provide updates.

When outsourcing your claims handling tasks, you need a provider that can handle each step, from the initial claim to the final payout.

• Handling initial reports: When someone first calls to kickstart a claim, call center agents will answer to guide them through the process.
• Documenting evidence: Case processing representatives will determine what type of documentation is necessary to proceed with the claim and then contact each party to gather the information.
• Verifying coverage: Agents will review the policy information to ensure that the claimant has active coverage that applies to their situation.
• Coordinating assessments: Call center agents will schedule adjusters and appraisers to assess damage or determine the value of an insured object.
• Providing policyholder assistance: Claimants and policyholders can contact the call center for updates or information about their claims.
• Determining liability: Call center agents can work through complex liability issues that are holding up the payout process, such as determining which insurance company is responsible for reimbursing a client.
• Managing payouts: Once a claim is approved, the BPO provider can coordinate payment to the claimant or provider.
• Following up on cases: Representatives can contact insurance companies, healthcare providers, and other parties to follow up on cases and ensure each claim is being reviewed in a timely manner.

When you switch to a BPO call center for your claims handling needs, you can enjoy several operational and financial advantages.

1. Simplifying your documentation: Processing an insurance claim often requires several different forms, from medical coding documents for healthcare cases to police reports for car insurance cases. Your BPO team will have a system to digitize and organize all your documents.
2. Improving follow-up: The claims process is often drawn out over a long period, especially if you don’t have anyone pressuring insurance companies to complete the claim. Call center teams have the resources to regularly follow up on their assignments and ensure that clients and providers are paid promptly.
3. Automating your workflows: BPO organizations have automated workflows in place to eliminate delays from your case processing workflows.
4. Decreasing costs: Instead of hiring and training an internal team to work on cases, you can hire a BPO team at a fraction of the cost. As your company grows and your case management needs increase, you’ll be able to get more support without having to make a significant financial investment.
5. Enhancing customer communication: Call center agents liaise between your company, customers, insurance providers, payers, and other parties involved with a case. They can keep everyone informed to reduce stress and increase confidence in your brand.

Finding a dedicated, experienced provider is the first step to getting the most out of your case processing services. To ensure your outsourcing partner is a good fit for your organization, thoroughly vet each option using these steps.

1. Assess their experience with claims: Research your provider’s experience in both general claims processing and your specific industry. For example, if you primarily process medical cases, you want a provider that understands the nuances of medical coding, billing, out-of-pocket maximums, pre-approvals, and other aspects of the health insurance landscape.
2. Discuss data security: Processing insurance cases often involves sharing sensitive financial, health, and personal details. Talk to your provider about how they comply with data privacy regulations and what cybersecurity measures they implement to keep your information safe.
3. Inquire about training: Research how the call center hires and trains its agents to ensure that your employees and customers are working with qualified, educated representatives.
4. Compare quotes: Secure estimates from your top options to determine which provider is the best fit for your budget. Be sure to factor in different circumstances, such as periodic increases in demand or add-ons for other services.

BPeople usually have to file insurance cases after a stressful experience, such as needing medical treatment or getting into a car accident. They may be unsure about their coverage, confused about their policy limits, or stressed about getting reimbursed in a timely manner. At Confie BPO, we understand what your customers are going through, which is why we use our expertise, customer service training, and insight to guide them through every step of the process. In the background, we tirelessly work on the administrative tasks necessary to get their claims approved. Here are just some of the ways we stand apart from other call centers and BPO providers:

• Highly trained staff: We’re proud to have a vast team of experienced, trained team members who know the ins and outs of processing claims in a variety of industries. We go through a complex training and onboarding process to ensure that our agents meet your high standards for quality and expertise
• Thorough documentation practices: Our systems for documenting policy and claim information will keep you organized and on track, even with the most complicated situations.
• Bilingual support: A majority of our team members speak both English and Spanish, so we can offer case translation services and bilingual support for your customers.
• Standout customer service: Although we leverage cutting-edge digital tools, we also add a human touch to each interaction. We understand why customer service is important and ensure that all callers are met with patience, respect, and understanding.

Here at Confie BPO, we understand that claims processing is the core of the insurance industry. Our community of agents includes hundreds of highly skilled representatives with years of experience processing cases, handling complex disputes, and fielding questions about insurance. We have the tools in place to oversee the entire case handling process from start to finish, from appraisals to arbitration. And each step of the way, we’ll provide seamless, up-to-date communication to keep all relevant parties informed about their claims.

Our team understands that each claim has unique challenges and circumstances and that your customers are likely hoping for a specific outcome. That’s why we handle each call with patience and care. We ensure your customers understand the case process and the specifics of their case so they’ll feel fully satisfied with the resolution of their claim.

Our attention to detail, focus, and commitment to perfection will help you process all claims correctly the first time, avoiding complex disputes. If a claim does need to be escalated, our expert team will handle the entire process to give high-priority issues the attention they deserve. From basic car insurance payouts to complex healthcare cases, our agents will use their experience and training to quickly resolve claims and boost customer satisfaction.

Submitting, tracking, and closing insurance cases is a complex process, but outsourcing providers are constantly striving to make it more efficient. BPO teams focus on streamlining processes to reduce the likelihood of human error, eliminate expensive manual labor costs, and decrease the amount of time it takes for companies or individuals to get compensation from their claims.

As a result, claims processing and insurance call center services are likely to focus more on automation over time.

This includes using AI tools to recognize patterns, process data, categorize cases, and track individual cases as they go through each step. For example, clients can connect with chatbots with natural language processing abilities to inquire about the status of their claims, get estimated resolution times, and ask questions about their coverage.

Get answers to your most pressing concerns by reviewing these common questions and answers about claims processing BPO.

Why Outsource Claims Processing?

Case handling is both complex and tedious, requiring a high level of knowledge, focus, and consistency. As a result, it can be challenging and expensive to train an internal team to process a high volume of claims.

BPO providers have trusted, reliable systems in place to maintain quality standards, eliminate errors, and follow up on all the cases you initiate. As your business takes on more cases, your provider can leverage their massive claims processing infrastructure to handle the increased demand — all without slowing down your internal processes.

How Do Claims Processing Call Centers Stay Consistent?

You may wonder how a single BPO provider can manage claims for different companies and industries. When you start working with your outsourcing partner, they’ll dive deep into best practices and guidelines for processing claims in both your overall field and your specific business. They’ll build out systems, databases, and checklists to ensure you can seamlessly transition your entire claims management process without any delays.

Qualified BPO providers also have strict quality assurance and training processes in place that are designed to ensure that all call center agents process claims to the same standards. Representatives with extensive case management expertise will follow these procedures and workflows to quickly resolve claims while still representing your brand with great customer service.

Can I Outsource Other Aspects of the Insurance Industry?

Claims processing is just one of many tasks you can outsource when working in the insurance industry. Your call center partner can offer customer service, technical support, policy management, onboarding, and more. They can also directly handle payments for premiums and other outstanding costs. Along with insurance-specific functions, call center and BPO teams can handle general operational responsibilities such as technical support, marketing, human resources, and more.

What Industries Can Benefit From Claims Processing Outsourcing?

Several sub-industries exist within the insurance field, including healthcare, finance, and automotive. Confie has an extensive team of insurance experts who understand the nuances of filing cases in these niche fields. Whether you need medical claims processing systems or support for property damage cases, your BPO partner can adapt to the key expectations in your field.

When Is the Best Time To Outsource Claims Processing?

The sooner you start outsourcing case processing, the sooner you can streamline your processes, save money, and provide a better experience for your clients. It can be helpful to time your transition to BPO services with other changes, such as updating your internal software systems or making staffing adjustments. This can help you reallocate your staff and integrate your data with your BPO provider’s systems without additional disruptions.