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Bringing Robotic Process Automation to the insurance claims filing process

Robotic process automation in insurance claims processing

Subhobroto Ghosh, Vice President for Virtusa, Log in to subscribe to the Blog

The insurance industry is unique. It doesn’t sell an actual product. It sells a promise of a service the customer may use in the future. In addition, at the time the customer redeems that promise by filing a claim, the customer is often in a very emotional place. The interactions the customer has at that moment shape not only whether the insurer retains that person as a customer by achieving renewal, but also can dictate the insurer’s reputation via word of mouth, social media, and more. Claims processing is the acid test on insurance.

Currently, claims processing is a highly manual and time-consuming process that is extremely error prone, and this makes for unhappy customers.

The good news is that certain newer technologies are potent enough to make a significant and positive impact on claims processing. Robotic Process Automation (RPA) can bring in that additional potency of speed and accuracy, the two key success factors in claims processing.

RPA is capable of making a multi-pronged attack on the inherent inefficiencies and challenges of claims processing, such as:

  • Manual data entry (leading to errors, delays, and fatigue)
  • Disparate source of information like paper, fax, scanned documents, email, voice calls
  • Legacy system navigation
  • Data access and retrieval challenges
  • Regulatory compliance

Automating Claims Intake with vCLAIM

Automating claims data entry in the back office at the time of First Notice of Loss and at other subsequent steps, using an RPA solution like Virtusa’s vClaims can not only reduce processing time but also help eliminate errors.

VClaim is Virtusa’s claims processing acceleration solution for insurance, which is built on Pega’s claims application by applying RPA. With this solution, an insurer company can automate claim processing with intelligent case management that reduces manual tasks, so the system can operate at the highest level of efficiency. The insurer can design and implement best practices by applying rules-driven processes across all lines of your business, products, and geographies. The system can learn from each customer interaction, and it can adapt and respond dynamically to each customer’s situation, delivering the best outcome.

The efficiencies are multiplied with the deployment of vBRAIN, VirtusaPolaris Digital Labor Management solution, which is the central command for "bots" working in the claims processing (or any other processes where bots are deployed).

Looking Forward

By managing claims processing using automation and AI you gain a clear competitive advantage because you have a system that can react on the micro side to changes in a customer’s needs and on the macro side to changes in markets, regulations, and economics. You reduce costs and risks because your workflows are now dynamic, yet consistent. Your ROI will improve because you're responsive to customer needs. You can also reduce financial risk because you are better positioned to identify fraud and remediate claims leakage.

Be sure to view a demo of vCLAIM and vBRAIN at PegaWorld Tech Pavilion.


Industry: Insurance Product Area: Robotic Process Automation Solution Area: Operational Excellence Topic: Operational Excellence

About the Author

Subhobroto Ghosh, Vice President for Virtusa

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