Research On Operation Process Optimization Of Health Insurance Claim Settlement Service Business Of AD Company

With the rapid development of China economy and people’s living standards getting higher and higher,the awareness of insurance among the general public has become stronger and stronger.Based on this background,the volume of insurance underwriting in the life insurance health insurance market has increased dramatically.As a health insurance company business spin-off and outsourcing service providers,third party management company of medical treatment insurance to participate in the health insurance as a independent operation,can effectively solve many problems existing in the operation process of insurance companies,such as settling rules do not have a unified information,do not have a high level of specialization of claims adjuster,manage compensate case rate is high,the claim settlement operation benefit is low.The timeliness and customer satisfaction of insurance claim service reflect the service level of the Third Party administrator company.As customer needs become more and more personalized,the original product and service processes of many third-party health insurance claims settlement management companies can no longer meet the rapid changes in market demand.Therefore,the original processes need to be analyzed,improved and optimized.Through the optimization of business operation process,enhance the company’s operation management efficiency and core competitiveness power of enterprise service,and create value for the company and customers.As a third-party management company of health insurance claims settlement service located in Northwest China,AD company is a major provider of third-party insurance claims settlement service industry in China.Facing the relatively homogeneous insurance claims service,it is difficult to meet the needs of customers,and its market competitive advantage is gradually weakening.In the face of the challenge of the growing company in insurance claims service business operations need to adjust quickly,with the help of science and technology,combined with scientific management methods and tools,have specific aim to optimize the corresponding operation process,positive innovation,constantly meet the needs of the development of the insurance claims settlement service business to company development to a new height.Firstly,this paper takes the operation process of insurance claim settlement service business of AD Company as the research object,and introduces the current situation of insurance claim service business operation of the company.Secondly,through the in-depth interview survey method,the problems existing in the company’s current business operation process are diagnosed and summarized: too long delivery cycle of claims data,poor output quality,low application degree of process automation,lack of effective business operation training process,lack of effective communication;The causes of the existing problems were studied and analyzed by literature research,fish-bone diagram and data analysis,and the key reasons were found out.Secondly,through the ESEIA method and the engineering parallel method,the optimization scheme of the operation process of health insurance claims settlement service was proposed,namely,to shorten the delivery cycle of claims data,improve the quality control of output products,enhance the application degree of process automation,improve the business operation training process,and strengthen effective communication to improve customer satisfaction.Finally,it is suggested to ensure the implementation of process optimization through the support of senior management,the establishment of reasonable operation and assessment management mechanism,continuous improvement of corporate culture and information system optimization.The purpose of this study is to reduce costs,optimize experience,and improve efficiency through the improvement of operational efficiency and operational service quality,and to help AD provide customers with high-quality and efficient services while improving operational efficiency and risk control capabilities,and constantly improve customer satisfaction and core competitiveness of the company,It has some practical reference significance for the optimization of health insurance claim settlement service business operation process in the third-party service companies.