Embrace Pet Insurance is a privately held insurance company that provides accident and illness coverage to dogs and cats in the United States. Located in Beachwood, Ohio, Embrace sold its first policy in October 2006 and now has over 15,000 policyholders with over 19,000 pet policies in-force.
Challenge
Prior to using the current solution, Embrace used Excel to run all prior paid calculations specific to claims processing. The entire process was manual and resulted in a significant amount of human error
Solution
The current solution allows Embrace to store all claim invoice data directly into CRM without the need for a manual process.
Project Overview
Embrace was an early adopter of Microsoft Dynamics CRM, having started using the product in 2006. There are currently two applications that use InRule, the Quote Engine Application and the Claims Management Application.
The Quote Engine Application generates quotes for insurance premiums online.
The Claims Management Application
- Calculates all prior paid claims
- Identifies claims missing information or in a waiting period
- Performs invoice calculations
- Generates an explanation of benefits
Prior to using the current solution, Embrace used Excel to run all prior paid calculations specific to claims processing and encountered the following issues:
- All coverage terms had to be found in CRM and manually input to an Excel file
- Too much room for human error
- Utilized experienced resources for a non-value add activity
- No way to do reporting on data saved within individual Excel files
- Time consuming
The Current solution allows Embrace to store all claim invoice data directly into CRM with the following benefits:
- Reduced the time required to adjudicate a claim from over 5 minutes to less than 1 minute
- Monetary savings of approximately $1.50/claim. With ~4,000 claims/month, that means an average of $6,000 per month in savings
- All prior claim-paid amounts and invoice totals calculated through InRule and saved into CRM
- Coverage terms pulled directly from the parent entity and put into InRule rule set
- Applies error checking to claims to notify adjusters of possible mistakes, prior to completing the claim
- Running asynchronous rule engine validation using JQuery Ajax
Benefits
- Reduces the time required to adjudicate a claim from over 5 minutes to less than 1 minute
- Optimize use of resources and subject matter expertise
- Significant reduction in development time
- Vastly improved data quality caused by human error
- Created a reporting mechanism for data that was previously not available in the manual process
“In our case, it would have taken a developer 6-9 months to do what we did in 6 weeks using InRule. More significantly, we can make changes on the fly as needed.”
Melissa Ing,
Business Process Manager/Claims Manager
