health insurance claims processor.
In response to the rapid and complex changes in health insurance declaration regulations, errors in declarations have occurred among our health insurance claims processor. To address this, we plan to develop a health insurance declaration verification system to resolve common declaration errors in the current declaration process. This system will check whether the declared data complies with health insurance declaration regulations, reduce the time spent by reporting personnel on verifying declaration data, and provide real-time feedback and suggestions to help correct any declaration errors.
Through the implementation of this project, we expect to improve the accuracy of declarations, reduce the occurrence of erroneous declarations, and further enhance the efficiency and quality of the declaration review process. Additionally, the results of this project will improve the work efficiency of our reporting personnel and enhance the performance and quality of the medical expenses department. We believe that the successful development and implementation of this system will have a positive impact on the future development and improvement of health insurance declaration services.
Automatic verification, real-time feedback, one-click update, daily notifications, saving time, effort, and cost.
System Stability and Reliability (Visualization platform, report distribution, daily push notifications, error prevention and detection).
Data Quality and Verification (Data tracking and analysis, automated verification, real-time feedback).
User Operations and Satisfaction (Training sessions, satisfaction surveys, optimized interface usability and experience).
Team Collaboration and Communication (Cross-departmental team meetings).
Efficiency Improvement (Reduced processing time, decreased labor costs).
Information Security (Daily scheduled backups, virus scanning, access control).
Before optimization, the total execution time was 40 seconds * 70 items = 2800 seconds, which took about 46 minutes. After optimization, the system login time is about 5 seconds, which is a full 45 minutes and 55 seconds slower than manual operation.
Quality Goal Setting: Goal setting is divided into phased tasks, such as external reports and visual reporting platforms, to improve the accuracy of submitted data and increase inspection efficiency.
Quality Management Process: The quality management process is implemented, including the steps for data inspection, responsible personnel, and time arrangements. For example, daily automatic inspection generates reports, which are reviewed by designated personnel, and corrections are made after identifying and addressing any discrepancies.
Data Tracking and Improvement: A work schedule is set up, with the system automatically batch-processing and updating the latest information at 2 AM daily. The execution log shows whether the inspection batch was successfully executed. If anomalies are found, common error causes are identified, and inspection rules are modified accordingly.
Improve efficiency: The automated inspection and declaration system can simplify the tedious manual inspection process for applicants every month, while also reducing the burden on IT staff to provide monthly inspection and declaration reports, thereby increasing processing speed and efficiency, saving time and resources, and making the declaration process more efficient.
