Claims AutomationBusiness ChallengeOur client is one of the largest insurance and financial services holding companies in the U.S. and has an expanding international presence. Internationally the company offers mortgage insurance and other payment protection products. The company serves over 15 million customers in 25 countries. Our client, the Loss Mitigation and Claims (LMAC) division for Spain, Italy and UK, was responsible to review all the mortgage insurance claims, matching their data to the lenders’ data and making sure that whatever is being claimed is within policy. The client agents are also responsible for conducting audits of the various mortgage lenders that purchase their insurance. The client evaluates whether the lender is meeting the norms and identify any issues with the lender conforming to the stated agreement. Twenty five agents responsible for over 800,000 loans required further automation to support their claims analysis and lender audits across the nearly 200,000 loan performance records per month. The client had purchased and implemented Salesforce.com as their CRM system but they were tracking and managing their claims and audit processing via spreadsheets on the desktops of agents across EMEA. SolutionPreviously auditors had to request their internal database group when they needed to query the data prior to an audit. This process often took several days and is now delivered in minutes at the direct request of the auditor using the Audit Sample Tool. Acumen Solutions developed this Audit Sample Tool on Force.com platform, which can dynamically query a large amount of loan data, based on filters defined by the user, creating the desired Audit Sample on-demand. The Audit Sample Tool also includes the ability to hand-select specific loans for audit and calculates the correct statistical sample size for that lender. The loan data is created in Salesforce as part of a scheduled extraction from the client’s in-house Sybase database, a process managed by Informatica Power Centre. The agents are now able to use this tool via simple user interface embedded in their CRM system to build their own sample of audit data using the criteria and filters they choose on demand. Data Recommendations – After significant business analysis Acumen Solutions recommended a data migration and data warehouse strategy for managing the client’s loan, audit and claims processing data. The client successfully migrated the full view of all loans and the entire history of audits to an Informatica Power Center in order to support the automated analysis process. Consistent Workflows On or Offline Access – Using Salesforce.com offline edition, auditor can capture the data they collect during an audit on site, with or without internet access. The new process is much quicker than the previous process (10 minutes per loan). The auditors have 3G wireless cards and could go online if the client allows or as a later part of the audit analysis but certain type of audits or clients may demand no internet access while they are on-site. With this solution they can still capture the data they require in the same manner as if they were on-line. Audit Sample Tool – Prior to or during an audit, the auditor must create a sample bucket of loans for their analysis. Acumen Solutions developed a tool using Visualforce to filter the loan data based upon the auditor’s criteria. Automated Workflows – Badly performing loans are pro-actively flagged based upon auditor criteria (e.g. a missed payment within first 3 payments periods). This process automatically creates a task for the auditor to examine particular loan(s). During the audit and approval process, scheduled reminders of document that are missing are automatically sent to the lender so that the auditor does not have to actively manage this communication stream but ensures that the auditors receives critical information in a timely fashion. Business Intelligence Recommendations – Each loan carries a great deal of “rules based information” for being compliant with company policy. Acumen Solutions reviewed the client and loan rules requirements and recommended that they consolidate their rules into a single engine which could then be queried from many different departments or applications including the Salesforce.com CRM system used by the client. Blaze Advisor (FICO) was the software chosen for the business rules engine. Acumen Solutions built a web service that queries the Business Rules Management Service (BRMS) directly from the CRM system. This function is used in both the audit and the claims process to reach an automated business decision for either approving or denying claims or determining when an audit is complete and compliant. When an audit is marked complete (all data is available) the automated business decision process evaluates whether or not each individual loan is either inside, or outside the policy agreement for that lender. Further integration led by the client
Technologies & Methodologies
Return on InvestmentClaims processing workflow was delivered and fully user acceptance tested within 10 weeks of the engagement. Average time to reach a decision took days in the manual world and will now take minutes. Automation of the work stream will allow the client to “automatically” process much more volume and frees up the agent time to focus on the loans that have issues or relationship that require more attention. Client may still take a loan out of the automated process and bring it to a review board but now those discussions are much more focused because everyone has clear cut data on why the decision is being recommended. Now much more information about the loan is available at their fingertips. |
Practice Highlights Acumen Solutions helped this leading business information and research provider by integrating systems to improve the performance of their customer service case management.  A leading global, full-service brokerage firm requested assistance with architecting, designing and transitioning its call centers using Acumen Solutions’ expertise to help achieve “world class” customer support and improved business operations.  This high profile regulatory agency needed to improve their ability to address high volumes of advanced legal and financial issues from constituents in a timely manner.  Initial rollout was achieved within 12 weeks to meet an aggressive go-live date. Due to the success of the course, the team’s role was extended to provide on-going training.
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 When Acumen integrated eBay's newly acquired payment gateways, the results included improved lead generation, sales, and marketing campaign response rates.  A major cable provider wanted to put a greater focus on their customers’ experience. Using Salesforce.com, we delivered a solution that not only improved call resolution and handling times but also reduced unnecessary truck rolls and increased sales.  A leading global management consulting firm challenged Acumen Solutions to deploy a videoconferencing solution that delivers significant ROI, saves time and money, increases productivity, and reduces their carbon footprint. We delivered!  Acumen Solutions delivered an advanced customer relationship management solution that unified sales efforts, improved management coordination of 30 nationwide divisions, and allowed executives to achieve operational excellence while improving performance.  Acumen Solutions was hired to develop and implement a large new web application to function as an end-to-end grants management solution. As a result, we were able to improve processes and increase employee productivity.
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