Insurance claims processing has a reputation for being both time consuming and error-prone with countless manual steps. But through a series of initiatives using .NET technology, CUNA Mutual Group (CMG) has been progressively automating this process, resulting in better accuracy, faster claims decisions, and now, integration between the claims process and new call centers.

Based in Madison, Wisconsin, CUNA is a leading financial services provider to credit unions and their members around the world. With assets of more than $10 billion, CUNA holds relationships with 5,000 credit unions and 40 million credit union members.

Claims Express achieved ROI in six months by improving claims payment accuracy, says CUNA vice president Craig Everson.

Craig Everson, a vice president at the Fortune 1000 company, cites a number of reasons behind the service provider’s initial decision to launch its Claims Express automation initiative about four years ago.

“The insurance claim process required new improvements in process automation, improved payment accuracy, automatic checks and balances, and speed to claim payment,” says Everson, who is vice president of CUNA’s customer operations program management office.

In 2006, CUNA augmented the system with better analysis and reporting capabilities, according to Everson.

And just last year, CUNA integrated Claims Express with a newly consolidated call center operation, which reduces the provider’s total of call center locations from 37 sites to all the way down to only three sites based in Fort Worth, Texas; Waverly, Iowa; and Madison.

“We now have an integrated and cost-efficient call center operations environment,” Everson contends.

The choice of an infrastructure environment to support the ambitious undertaking was the first challenge CUNA faced during the early development stages.

The financial services provider opted to go with Microsoft .NET as the underlying architecture for a new and streamlined claims processing system, a move also seen as paving the way for future enhancements.

CUNA contracted with MajescoMastek, a Microsoft solutions specialist with a background in disability and life insurance, to help build the custom claims processing system.

The resulting Claims Express system includes five main systems modules: a user interface generator, claims processing engine, audit engine, product configurator, and work task generator.

Beyond automatic claims processing, Claims Express also is designed to provide easy definition of business rules. The system automates eligibility determinations, payment calculations, workflow, accounting, tax reporting, and required correspondence.

Administrators can set different rules for each financial product, as well as for various states in the US and provinces in Canada.

Tools used in building the system included the .NET Framework, the Microsoft Windows Server family; Microsoft Visual Studio .NET development toolkits and utilities; and Web services such as XML (Extensible Markup Language), SOAP (Simple Object Access Protocol), and WSDL (Web Service Definition Language).

Everson is pleased with the results. “Claims Express achieved ROI in six months, by improving claims payment accuracy,” according to the vice president.

Decisions on claims have been shortened to 10 days, resulting in a 75 percent decrease in claims payment backlogs, now down to five days.

As a next step, CUNA created a consolidated call center that replaced a previous configuration involving not just 37 different call centers but 300 different “800” numbers, five claims processing groups, 25 core product administration processes, 57 core administration systems, and more than 1,500 employees.

Now, claims processing is integrated with the call center and new/business/product administration into a back-office system with data warehousing capabilities. Front-office functionality brings together financial services products with distribution.

Finance, IT, HR, and procurement personnel, for example, all share access to these consolidated operations.

As a result, the internal “customer experience” has now stepped from being “siloed” to “optimized,” according to Everson.

Meanwhile, as he sees it, CUNA is operating in a climate of increased IT complexity, characterized by rapid growth, “build, buy or rent” decisions, and strong needs for data security and compliance.

At the same time, market shifts are creating new opportunities. Today, US credit unions number only 8,800, and by 2010, their ranks will be reduced to about 7,240, Everson estimates.

“But in 2010, there will be over 93.3 million US credit union members. Today, US credit union membership is on the rise to over 80 million,” he says.

Ultimately, Everson contemplates expanding CUNA’s online experience to external customers, including credit unions and even credit unions’ own customers.

www.cunamutual.com

www.majescomastek.com

By Jacqueline Emigh