The insurance claims analysis is one of the most important process that is taken up by insurance companies. This is pertaining to the management problems faced by insurance companies during certain risks and changes that occur in the market. The analysis is mostly dependent on decision making. The claims are all analyzed through various decision making processes.  It is important that the claim analysis is managed efficiently since this concerns the insurers directly. The data is gathered for the insurers. The analysis is able to show whether the decision made by the insurer in terms of selecting the insurance policy.

The handling of claims can be a complicate process for more companies. The analysis involves processes like opening and closing the claims, reserving them, making the payments and even carrying out the recoveries as well as working with providers.  These claims can be linked to fraudulent activities. The information that is gathered through the analysis is used to help eradicate fraud.

Sample Insurance Claims Analysis

The following is an analysis report that has been created by CLEAN AND CLEAR Insurance Analyzers. This was done on behalf of WE PROTECT Insurance Co.

Insurance Policy: Medical Claims Policy

Insurance Policy No.: 222212

Date: 2.3.2012

The report contains details that have been segregated into five segments for convenience:

  • Monitoring of Claims for the Parties concerned: Payments, opening and closing of the claims for this insurance policy has been done efficiently with minor outstanding arrears.
  • Service providers for claim parties: All services have been provided as stated within the policy with minimum hassles.
  • Claim Element Analysis: All premiums, coinsurance and copayments have been received on time
  • Run off analysis: Future reserving of the company has been handled successfully so far
  • Fraud Detection: There have been no fraudulent issues related to this policy.

Comments are closed.