Document sharing bottlenecks in claims are not a people problem. When documents have inconsistent controls, different permissions depending on the user access level, and high volume pages (documents relating to a claim can number into the tens, or even thousands, of pages), the right tool matters. And, since many claims documentation software and platforms are not built for the complexity it requires, the end user must often make do with a platform that is slower or less useful than they need.
The result is IT bottlenecks that slow down the process of claims. In claims, users bump into incorrect access permissions, are unable to open required documents, or must send requests to other users before resuming their work – and the claims process halts in its tracks. While these roadblocks might seem like a minor annoyance when it happens, they can add up! Without claims processing automation, claims adjusters, legal experts, and administrative teams are forced to juggle tasks in order to access these documents, interrupting their workflow and causing as much of 40% of someone’s productive time.
The right claims documentation software with secure document sharing solutions should eliminate these bottlenecks by making the right controls easy to apply, track, and change at scale. IT leaders sit at the cusp of a new and exciting tech era, especially in claims – where the right balance of security and speed can mean leading in your market or industry.
How Claims Documentation Software Can Make Change
IT decision makers at mid-to-large insurance carriers are already pushed to balance legacy systems with emerging AI tools. In a report by KPMG, 58% of insurance professionals feel overwhelmed by AI hype. At the same time, tech readiness is becoming an issue, with few insurance leaders prepared for issues like cyber attacks.
Claims teams are moving fast. With parts of the claims process becoming seamless, fast, and AI enabled – like instant, or real time, payments in some cases – there are still major areas for risk. IT decision makers need a claims documentation software with document sharing solutions that are capable of speed, without leaving behind the tools that work to protect the business, and the claimant’s, safety.
Granular user permissions, a fully auditable trail, and correct access controls should always be part of the IT toolbox in claims. The right claims documentation software platforms make these document sharing protections, controls, and security mechanisms easy to track, apply, and scale.
The Real Risk of Getting User Permissions Wrong in Claims
Claims files are inherently sensitive. Each claim can contain tens of thousands of pages related to a single patient, injury, or accident – and each page could contain sensitive, relevant patient data. Social security numbers, health identifiers, or medical histories and details can all become exposed in the process of a claim, and exposing it to the wrong parties can have major consequences.
The average cost of a data breach for a healthcare organization is $8 million, but even if the breach is not large scale, there is plenty of risk. When permissions are not set correctly, very sensitive documents can be exposed to people who do not actually need access to them. Without an audit log, these breaches might never be discovered.
In Insurance Corporation of British Columbia v. Ari, the ICBC was held responsible for one of its employees breaching customer data. The employee shared the customer data that she had access inappropriately with a third party, and a number of these customers were targets of arson, shootings, and vandalism. Poor controls can have major consequences for not only the organization, but for other parties related to the case.
External sharing – like with a law firm, IME, or third party medical reviewer — can up the risk level even more. If an enterprise does not have good controls over who sees, has seen, and will see sensitive patient data, there is always room for a breach.
What Secure Document Sharing Actually Looks Like for IT Teams
Trust is important, but so is speed! How can IT teams balance both efficiency and security on a claim? With secure sharing, access, and audit trails. Role based permissions can help standardize user access across the organization using claims documentation software, so that certain users are given permissions automatically – while limiting the number of manual permissions required for the claim. Permissions should be given based on the use case, specified in terms of time or scope, or limited to view only.
For example, if a bodily injury claim has multiple stakeholders. The claims adjuster requires access to all documents in the file. Their supervisor might also need access to the full file containing these documents in order to review. The legal team might be given permission to access some of the documents later on in the claim, while an IME or third party examiner might be given access to a certain subset of documents to view.
A secure document sharing workflow (like Wisedocs’ WiseShare) is designed to support these kinds of claims and is built, configured, and tailored to your existing claims environment.
Sharing documents should be part of a configurable, shareable claims documentation software for document sharing. Teams shouldn’t need to choose between speed and control, both are possible and necessary for defensible modern claims processes.
FAQ:
What are the biggest document sharing bottlenecks for IT teams at insurance carriers?
Infrastructure and permission complexity slows claims documents down. When users are busy granting access or pulling documents via siloed systems, manual access requests, and inconsistent sharing protocols, users take longer to process each claim. These gaps also add risk and create compliance exposure at scale.
How should user permissions be structured for claims document sharing?
Role based access, time-limited sharing, and appropriate permissions given automatically. When you apply the principle of “least privilege” automatically, each user has access to only what they need. These changes can be configured at the workflow stage, rather than applied as part of a blanket policy.
What compliance requirements should a secure claims documentation software meet for insurance carriers?
SOC 2 is the baseline for compliance systems, and covers areas like security, availability, processing integrity, and privacy. IT leaders should be asking vendors whether their claims documentation platform meets the SOC 2 requirements, as well as other important aspects of both privacy and security. Are audit trails kept? Where does your data reside? How is access controlled?
How does WiseShare help carriers solve secure document sharing at scale?
WiseShare is a purpose-built solution created to balance both compliance and workflow demands in claims. With controlled sharing capabilities and the speed, Wisedocs helps prepare your claim files for review before a human touches the file – and this includes user permissions. Most claims organizations manage sharing and document exchange via unsecured file transfers or email. WiseShare starts this process before your team even touches the claim.
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