Health Insurance Solutions

Claims Processing

'I want to be able to make accurate, consistent claims decisions quickly and cheaply. Oh, and by the way I want to be able to change the criteria whenever I want to without having to go back to IT.'

If this sounds familiar then Haley solutions can help. By automating the decision to payout the claim using business rules authored in native language the following benefits can be realised:

Greatly reduced processing costs
Faster turn around on the claim, improved customer satisfaction
Reduced reliance on highly skilled staff, lower training costs
Improved decision accuracy, consistency and transparency
Faster implementation of policy changes, improved time to market

Governance, Risk and Compliance

Insurance is a heavily regulated industry requiring a great deal of time and effort to keep the auditors and regulators happy.

Haley Risk & Compliance is a highly integrated solution that can greatly alleviate this burden, automatically linking the Requirements, Obligations and Controls and allows you to easily build and manage your Compliance Plan.

A centralised Control Framework allows those same Controls to be linked to your Risks and Assessments and with a centralised Incident Management System, Haley Risk & Compliance provides a complete view of your organisation.

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Underwriting

The decision on whether to accept an insurance application is one of the most important an insurance company can take, especially for large, complex corporate policies. Getting it wrong can be very costly.

Haley Decision Services can help by capturing the insight and expertise of the underwriters into business rules that can then be consistently applied to every customer. This can help not only with the decision on whether to cover the customer's risks but also the application of premium loadings and discounts dependant on the customers particular circumstances.

If you have a wide variety of products it can also provide a best fit, help with cross-sell and up-sell and therefore improve your share of wallet.

Pre-authorization

Leading health insurance providers use Haley to tell policy holders which treatments they are eligible to receive before treatment is provided. This service enables provides to rapidly convey accurate policy coverage information across multiple communication channels including web, automated phone response, and agent networks.

By using Haley solutions, you can:

Provide 24/7 automated, self-service pre-authorization guidance to policy holders improving quality of service and reducing customer and agent support costs.
Reduce cost of maintaining pre-authorization information against individual and group policy details.
Reduce probability of providing erroneous pre-authorization information to policy holders that result in subsequent claims dispute.

Billing Operations

Leading insurance providers and third party administrators use Haley to enhance their billing operations capabilities and to improve accuracy, customer service, and internal operating efficiency.

Haley solutions can help you:

More rapidly process accounts to improve cash flow and reduce overall billing costs.
Reduce operating costs while increasing the billing speed by realizing higher Straight through Processing (STP) percentage.
Enable consistent decision making rules to leverage expertise and knowledge to reduce billing errors.
Make billing policy changes more rapidly across your entire organization.

Benefits Explanation

Leading insurance carriers and third party service providers are leveraging Haley to clearly illustrate to policy holders and insurance administrators the benefits contained in their policies. In doing so, Insurance providers can increase customer satisfaction and improve sales and operating efficiency across both captive and indirect channels.