Claims management for a large health insurer in Mexico

Qantev helps one of the top 10 Health insurers in Mexico increase their straight through processing rate   

This leading insurer is a subsidiary of a global insurance and asset management company. Operating in Mexico, this insurer provides a wide range of insurance products, including health, life, auto, and property insurance, as well as investment and savings solutions. With a focus on customer service and innovation, the company aims to offer comprehensive coverage tailored to the diverse needs of individuals and businesses, and has chosen Qantev to streamline its health claims management processed end to end.

The current claims processing system and processes were heavily reliant on manual tasks, leading to inefficiencies and vulnerabilities.

• 100% of claims manually processed
• 5 to 7 days claims turnaround time including 2 days for manual data entry processing
• 9% Estimated leakage from fraud, waste and abuse
• 10% year on year medical inflation since the pandemic

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This insurer has chosen the Qantev platform, adopting it to solve the challenges it was facing. The platform was implemented within their ecosystem in 6 months.

• Deployment of the Qantev claims management module 
• Deployment of  the Qantev fraud, waste and abuse  module
• Deployment of the Qantev OCR & data acquisition module

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Qantev has enabled this insurer to generate quick business improvements, as follow:

• 60% straight through processing rate achieved in 12 months
• 88% of data acquisition processes automated
• 50M MXN cost savings in 12 months
• 40% reduction of the average turnaround time
• ‍Positive ROI after 4 months of production

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