wibli
Insurance Claims Excellence

Claim reviews are conducted in a state-of-the-art Questionnaire instrument with build-in standardized rigorous methodology that allows the experienced internal claim experts to identify fast and easy overpayments, missed opportunities or other issues that may lead to process leakage. The review is executed by internal best-in-class claim specialists. The methodology foresees precise calculation of the leakage thanks to smart checks.

When the reviewer finishes the case the system automatically forwards the results to the Audit supervisor. The supervisor verifies the completion of the case and checks for discrepancies - he can either approve the case, reject the case or reassign the case with a feedback to the reviewer. The management is done in a detailed cockpit with the respective filtering options.

The reviewers can ask questions to the Audit supervisor. The answers and the status of the questions are tracked and accessible at any time providing full transparency of the review process

The Audit supervisor has a comprehensive overview on the calibration level, specific challenges and frequent disagreements on file responses and leakage scores among peer reviewers.

The Audit supervisor has an instant view on the Leakage summary by handling phase, by segment, by question, by reason as well as by leakage type. The extrapolation selection provides the possibility to view the leakage for the entire claim portfolio.

The Audit supervisor has the flexibility to use not only the standard set of reports but to build customized dashboards thanks to the downloadable spreadsheets in multiple formats such as .pdf, .csv or .xlsx. The incorporation of the reports in existing client‘s BI solutions has never been easier.