Current Date :July 21, 2024

Quality Assurance for Insurance: Getting Automated Claim Adjudication right

The global pandemic not simply was a health scare, but it also led to a lot of economic crises. While Insurance companies in such times perform a significant role in providing a cushion and help companies handle the risks, they too have been under tremendous stress. Not only are they are subjected to volatile financial markets, but they also require to adjust to the current norm and yet be successful in their venture.

As per a study, “The Insurance carriers have expended roughly 48% of their market value since the crisis began; with life & health insurance vehicles especially hit hard with average drops of 58%. The cost of COVID-19 testing and treatment is expected to squeeze U.S. health insurers’ gains, which could lead to larger premiums in 2021.”

Evolving times and customer requirements need technology adoption

The business imperatives and the developing customer requirements have made it critical for insurers to adopt disruptive technologies such as Blockchain, AI, and IoT. Digital transformation is no longer an option for them, and one must apply these technologies over the value chain for enhanced brand differentiation and greater profitability.

Most of the QA programs usually take a back seat when decisions are made for the future course of technology transformation. Companies that display agility and a commitment to regularly unlearn and learn from the experience will receive benefits as they walk along the digital transformation course. Those who choose to bide their time and remain careful will be at risk of being left behind.

With the pandemic spurring on the need for digitalization, accelerating the adoption of automation has become critical in the role of the claim handling and adjudication process, a vital aspect of insurance companies.

Why is QA Assurance for Insurance so Challenging?

The issue with the QA assurance for insurance is not about executing new technologies or using new tools. It is even not about using the right approaches.

The problem is Test Coverage:

  • Even though human tester can generate test cases, they can’t give the required test coverage. There is a great chance that the false positive or false negative cases will pass unnoticed.
  • Whether it is a top-down, bottom-up, or functional-analysis strategy, each of them or a combination gives some testing coverage. However, this level of preparation and execution is often skipped in the case of time by the organizations. They ignore the coverage plan, without which much of the test coverage is skipped, ending in error-prone testing.
  • As an outcome of the poor performance of QA assurance for insurance, no one assumes it to work. They believe that they will get mediocre outcomes and are ready to accept the cost of recovery as a regular cost of doing business, instead of increasing test coverage.

Quality Assured Automation of Claim Adjudication

A bad claims experience can lead to about 84% of the insured and proposers exchange their insurer. This is a dangerous enough rate to highlight the importance of automation and customer satisfaction through the claim adjudication process.

Not just does a traditional claims processing need various days due to manual intervention and a lot of paperwork, but there’s also the difficulty of even small errors such as a misspelled patient name that can make a claim be denied.

In an age where a customer’s voice is a significant mode of improving or destroying one’s reputation, insurers must know that there is a requirement to adapt to the new needs in the digital era. It is important, thus, that the claims are submitted electronically where the software can assist prevent errors before it is presented for payment.

This is where automated claim adjudication appears into action.

Quality Assurance is important for Insurance organizations to earn the trust of their consumers, and to run their business seamlessly without any interference. Getting the automated claim adjudication right for the first time is what the insurance firms should vouch for.

To automate any section in the Insurance sector, companies require to emphasize 4 major factors:

  • Understanding the end-to-end flow
  • Writing well-defined business test case scenarios
  • Building the right automation framework suite and
  • Estimating the testing state of the automated software

The creation of end-to-end digitization of the course of a claim, that performs features such as digital claims status tracking and automated claims segmentation will do miracles for insurance firms.

With continuous integration of automation suites, one can accomplish more clarity in the test coverage, thus drastically decreasing the test efforts. All the positive and negative scenarios encompassing the claim adjudication workflow must be included in the automated framework so as to assure 100% accuracy.

Benefits of Technology Adoption in the Insurance world

With the COVID-19 outbreak, we have been examining the various changes that have swept over the insurance industry.

The potential of the distributed ledger technology (Blockchain) to promote360-degree transparency, accountability, and robust data security is large. Identifying and managing false claims could become very easy with the usage of Blockchain. Smart Contracts is a real application of Blockchain that can be utilized by insurers and associated stakeholders to swiftly access and update related data over claim evidence, 3rd party review reports, and other related reports for robust risk mitigation.

AI can thus help Insurance companies become more customer-centric and digitally-enabled, so as to give the best possible “customer experience, performance, and effectiveness.” Proper usage of AI coupled with Big Data Analytics can assist insurers to analyze and make sense of the tonnes of data available to give maximum client delight.

TestUnity supports clients in their digital transformation course & helps them deliver enhanced customer experience & obtain a competitive advantage. Our testing services portfolio and matchless track record verify us as a trusted advisor and preferred technology partner for clients. To change your legacy processes with our software testing services, schedule a discussion with TestUnity experts today.


Testunity is a SaaS-based technology platform driven by a vast community of testers & QAs spread around the world, powered by technology & testing experts to create the dedicated testing hub. Which is capable of providing almost all kind of testing services for almost all the platforms exists in software word.

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