Best Practices to Modernize an Insurance Claim Payment Processes

Having provided the services, the healthcare facilities should receive payment. Since having insurance is a matter of life, dealing with claims is often the insurer’s responsibility. The demand for modernizing payment processes is driving the healthcare industry to find better ways to make the insurance claims payment processes simpler and more secure.

Sometimes the medical billing procedure is so confused, that it takes the insurer not just days, but weeks to review the claim and pay it out. The question is: “should insurance companies automate and modernize claim experience?” and the answer: “steadily yes!”

There are several ways the insurance organization can consider to improve the insurance claim payment process. This article outlines key points on how to process insurance claim payment in a modernized way and how insurance organizations can benefit from insurance claims process automation.


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Insurance claims payment process

Have you ever wondered how does the insurance claim payment process work? We are going to give you the full vision.

When an insured files a claim, he’s requesting the insurance company to pay out the costs needed to help you restore damages. Much depends on the insurance policy. 

Right after the accident happened, the first thing for him to do is to learn the policy details. It showcases under which circumstances the insurance company should approve the claim. Usually, the insurance company sends the agent to investigate the issue. If the cause of the damage is confirmed, an insured person receives compensation, if not, the claim might be denied.

How quickly the payout is processed depends on several factors:

  • When the claim was filed;
  • Whether the insurance company has all the required documents;
  • How quickly an insured meets the insurance agent;
  • The number of people involved.
Best Practices to Modernize an Insurance Claim Payment Processes 1

How does the insurance claim payment process work

If you have ever wondered how the insurance claim process works, the workflow is pretty simple. It consists of several points:

  • The initial payment isn’t final. Right after the incident, the adjuster inspects the damage and offers a certain sum of money, depending on what is written in the insurance policy. Usually, the first payment the insured gets from the insurance company is a prepayment, not the final sum.
  • He may receive multiple checks. Each category of damage requires a separate check. For example, when both the furniture and the structure of home were damaged, the insured will receive two checks.
  • The personal belongings will be calculated on cash value. As soon as the incident happens, the insured should submit the list of damaged items. The first damaged belongings’ evaluation he receives from the insurer will be based on the cash value of the items. 
  • To receive compensation for the items that should be replaced an insurance company may ask for proof of purchase. It will pay the difference between the cash value of your initial purchase and the full cost of the item of the same size and quality. Thus, keeping copies of receipts is a good idea.

Claim payment process best practices

When it comes to claim payment, the process can be slowed down just because of missing to address weak points on time and failing to introduce modernization features. Here are 7 insurance claim payment options to consider to ensure a smooth and secure payment process.

Automate Basic Billing Functions.

Delegate doing monotonous tasks such as filling the claims, generating payment reminders, and dealing with medical coding to the automated system instead of staff. Employees can concentrate on more patient-centric tasks at that time.

Introduce Virtual Claim Payment Card.

This feature will supplement your system. It’s not a physical card, but a unique 16 digits computer-generated number that is solely used between payer and payee. This innovative payment solution simplifies the payment process for both suppliers and consumers.

Best Practices to Modernize an Insurance Claim Payment Processes 2

Clarify the Payment Process Upfront.

Transparent communication is one of the core keys to ensure efficient medical claims billing efforts. Make sure your new patients are aware of the services paying process. 

Outsource Your Most Problematic Collections.

As a service provider, you may be reluctant to use outsourcing services. However, it’s an important point to keep your business running. Using a tried party relieves your pain points, as you delegate problematic tasks to experts. 

Maintain and Update Patient Files.

If you don’t keep patients’ files updated, you cannot expect to properly manage claims billing. You’ll need to ensure that the patient’s information is relevant every time he pays a visit. 

Follow Up on Delinquent Claims.

How much is your practice lacking for the services provided? Answering this question, you’ll learn the percentage of delinquent claims awaiting service. At least one employee should keep an eye on account aging to determine which claims haven’t been paid on time. 

Track the Process Carefully.

This is one of the key points on how to improve the medical claims payment process. Most claims start from the call center. After the claim is reported, the customer care representative fills in all the required data in the worksheet to hand them over to the claimant.

Consider Our Company Your Trusted Partner

While insured individuals want to feel financially protected, insurance companies want to never suffer a loss. Like it or not, accidents happen and insurance companies are obliged to pay out claims. 

To make the health insurance claim payment process less painful and more smooth, consider delegating the development and support of important software features to a trusted partner. Empeek offers outsourcing software development services to help healthcare organizations create and maintain medical software according to their needs. 

In case you’re shortlisting your future partner now, learn about our services. We have hands-on experience in features such as file encryption, secure data sharing, cloud integration, and financial data analysis among many others.


Let us help you achieve greater business results - our software development experts push the limits to deliver the most advanced solutions.

Final Thoughts

The speed of processing insurance claim payment is a core feature of a successful customer experience. By modernizing the insurance claim payment process, insurance companies can make it a lot faster and secure. Following 7 claim payment process best practices, the payment process will not only take less time but also the risk of occurring errors will be eliminated. The faster the insurer can process the claim payment procedure, the better overall user experience is.


What is the claims payment process?

This is a flow of actions taken before the claim is approved and paid out.

What is the most important feature to improve insurance claim payment process?

Consider introducing Virtual Claim Payment Card. This innovative payment solution simplifies the payment process for both suppliers and consumers.

How does the health insurance claim payment process work?

The flow consists of several steps: the insured person gets initial payment and may receive multiple checks later on. The damages are evaluated in cash and the insured receives compensation.

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Written by:
Roman Konstantinov Roman Konstantinov Managing Partner & Co-Founder
Roman is the co-founder of Empeek who brings a breadth of knowledge to build, scale and transform healthcare organizations. He specializes in revitalizing struggling businesses and turning them into profitable enterprises. By emphasizing automation and effectively navigating the transition from startup to a sustainable and scalable model, Roman drives remarkable transformations to ensure long-term success.

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