3 Use Cases for Case Management Automation

Michael Eisner October 29, 2020 Case Management

insurance

Organizations located all over the world spanning nearly every industry utilize case management software as a means of boosting productivity and making more informed decisions. Yet case management is not suited for every task, particularly for processes that cannot be 100% automated. To put it another way, the discipline of case management always involves some level of human interaction or judgment.

About 10 years ago, Forrester Research broke case management use cases down into three categories: service requests, incident management, and investigative uses. Gartner also identified distinct categories of use cases for case management automation. These include things like HR lifecycle management, regulated cases in banking, and customer-focused cases like insurance claims. To better understand the potential uses of case management automation, we will explore 3 different applications in 3 different industries.  

Case Management Use Case #1: Information Security in Banking

Preventing fraud is one of the biggest challenges that banking institutions face. In 2018, fraud against bank deposit accounts totaled $25.1 billion, a $6 billion increase from 2016. Add to that total imposter scams and identity fraud cases, which also account for several billion dollars of losses each year.  

Banks use a variety of automation solutions to identify and prevent fraudulent activity. For the past decade major banks have relied on anomaly detection which is an artificial intelligence (AI) technology for identifying deviations. Banks use this technology for automating fraud, cybersecurity, and anti-money laundering business processes.

To provide an example, anomaly detection is often used for detecting fraudulent payments. The automation software notifies human monitors when it detects deviation from normal patterns. The monitor then approves or rejects the notification, and the system improves its detection ability over time through machine learning (ML). Yet it is not possible to entirely remove the human element from this process.

Another example of bank use of automation involves detecting fraudulent online banking login requests. While banks can automate much of the verification process, there will be suspicious activity that deviates from the normal verification process. In these instances, banks can use case management automation to get these cases resolved quickly without having to beef up their security and compliance teams. 

Case management in banking offers many benefits. In addition to reducing fraud and financial losses, banks can: 

  •   Fix operational inefficiencies
  •   Increase productivity of their fraud teams
  •   Improve compliance and reduce regulatory risk
  •   Reduce the number of false fraud triggers
  •   Boost profitability and lower fraud management costs

Case Management Use Case #2: Service Desks

Traditional service desk processes are full of inefficiencies. Human technicians receive calls or emails from end users. The technicians must assess claims, input them into one or more systems, and open support tickets. From there the issues are either resolved or must be escalated, requiring the technician to reach out to one or more parties and again with the user following resolution.

Service desks must also deal with inconsistent workflows. Much like a mechanic’s shop, it is hard to predict the number of customers that will come in on any given day looking for repairs. As a result, it is hard for traditional service desks to cope with staffing challenges.

Organizations are increasingly turning to case management automation solutions to streamline workflows, increase efficiency, and reduce the operational costs of service desks. There are many examples of service request business processes. One commonly used function involves automating the process for recovering lost passwords. Only in the unusual case where the request falls outside of the automated workflow will human involvement be required.

Service desks also use case management automation software to route support tickets to the right people. When the ticket is opened and submitted, it is automatically sent to the right department to get the matter resolved. The organization can also automate the response to the end-user to let him or her know that the issue has been resolved and even request feedback. Other common uses for service desk case management automation include onboarding tasks and knowledge management. 

Case Management Use Case #3: Claims in Automotive Insurance

Quick claims processing and settlements are key to the success of auto insurers. But without case management automation software the claims process is prone to costly errors, requires extensive manual processing, and often results in dissatisfied policy holders. According to research conducted by McKinsey, automation can reduce the cost of a claims journey by as much as 30%.  

There are many potential uses of case management automation within the automotive insurance industry. One involves using automation to recover third-party insurance reimbursements. This is one of the most time-consuming aspects of the claims process, requiring agents to exchange claims information with numerous outside parties. Once received, the information must be reviewed and processed, and accounts reconciled. With case management software, insurers can automate much of these tasks like correspondence and the recovery of reimbursements from third-party insurers.

Another important feature of case management software is the ability to escalate claims and route them to the appropriate party for resolution. Insurers simply automate high-volume and repetitive claims correspondence and tasks through rules-based processing. Anything that falls outside of these rules is escalated and receives human intervention. This allows insurers to settle claims faster, provide superior customer experiences, and reduce costs.     

How to get started with case management automation

If you are new to case management automation solutions and not sure where to start, look at costly and time-consuming processes that require a high level of human intervention and decision-making. The case management use cases discussed above are great examples of ideal processes. For more information on case management automation check out ProcessMaker’s industry leading low-code business process management software.

 

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