Page 36 - The Insurance Times October 2025

Making the Invisible,

Visible: The True Path to

Technology driven

Operational Efficiency in

Health Insurance Claims Deleep Murali

Processing Chief Executive Officer
Zscore Technologies

The need for a human-in-the-loop to validate and remediate digitization is critical. It serves as a great
way to validate data and ensure quality for upstream applications to consume. Without human
involvement, we risk the authenticity of the data and thus reduced trust.

I n the complex world of health insurance claims, the Gathering data is a time-consuming activity, not years but
definitely weeks and in some cases months. It is defined by
pursuit of operational efficiency is paramount. Technol-
the amount of data that gets generated every day for ma-
ogy offers powerful tools to streamline processes, re-
duce errors, and accelerate turnaround times. How-
ever, the promise of "Achieving operational efficiency using chine learning systems to hone themselves.
technology" is not a destination reached on day one of an The primary outcome is to ensure every day activities are
implementation. Instead, it's a journey of continuous im- not affected and the new system is able to outperform the
provement, fueled by the ability to make previously invis- previous benchmarks consistently.
ible inefficiencies, visible.
Uncovering Hidden Bottlenecks: Legacy processes
Why Operational Efficiency Isn't a "Day and ingrained habits often mask underlying inefficiencies. It's
only when new technology starts to collect and present
One" Deliverable? data in new ways that these "invisible" chokepoints,
Many organizations invest in new technologies expecting an manual workarounds, or redundant steps truly come to
immediate, transformative impact. This is even more diffi- light. These aren't always apparent during initial design or
cult when it comes to a problem like claims processing. rollout.
While initial improvements are often seen, true, deep-
seated operational efficiency is rarely an instant outcome. Right from Document Classification, to digitization, to adju-
Here’s why: dication of claims and automated quality control to ensure
Baseline Establishment: New systems and technologies high accuracy of digitization. These activities when moved
first need to operate within the existing environment to into automation reveal gaps in the process that need to be
gather data and establish a performance baseline. This ini- addressed. Most of these issues are usually data quality
tial phase is crucial for understanding the current state, not challenges and increased human involvement to address
the optimized state. them.

The Insurance Times October 2025 33