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IDENTIFY CLAIMS TO BE AUDITED Based on the organization's criteria, Ventiv RPA bots can search for claims that require a detailed audit. Criteria could include: reserve levels; a fatality; major injury; gap between event and filing date; or selected randomly. RISK AND SAFETY NOTIFICATIONS Ventiv RPA bots can review claims for safety and risk management concerns. If an employee has made multiple claims, for example, safety managers could be notified and require extra training. If a location is experiencing multiple slips and falls, risk managers could take loss-prevention measures. CLAIM ASSIGNMENT A Ventiv RPA bot can review incident reports or first notices of loss and assign them to the appropriate adjuster. Organizations establish assignment criteria, such as location, workload, line of insurance, primary language, and vacation schedule. AUTOMATE VERIFICATION OF POLICY COVERAGE A Ventiv RPA bot can read scanned documents or access policy records maintained in a software system. Then, the bot can confirm coverage for the claim being made. AUTOMATIC APPROVAL FOR MEDICAL- ONLY CLAIMS A Ventiv RPA bot can be a virtual adjuster for specific medical-only claims. The bot verifies coverage. Then the bot determines the payment threshold meets the organization's criteria. The bot then continues to monitor the claim and approves payments as long as they are medical only. AUTOMATED CLAIM CLOSURE If a claim meets designated criteria (for example, no activity in the previous 90 days), a Ventiv RPA bot will evaluate the claim's eligibility for closure. The bot can execute actions that will prompt closure, including emailing the claimant and advising that closure is imminent. Or, the bot will notify adjusters of claims that meet all or most of the criteria necessary for closure. RESERVE MANAGEMENT Ventiv RPA bots can monitor the impact that processed and scheduled payments have on reserves. For example, as medical bills are paid out on a claim, the bot will project the reserves and whether they will continue to be adequate. The bot will also factor in scheduled medical bills. IDENTIFYING CLAIMS TO SETTLE AND PAY A Ventiv RPA bot can advise adjusters on claims that likely not suited for litigation. The bot would compare the characteristics of open claims to those that went into costly litigation. The bot would present its findings to the adjuster for review and decision-making. REINSURANCE OR SUBROGATION RECOVERY A Ventiv RPA bot can review claim characteristics and determine if there are ways to reduce payments by pushing liabilities onto third parties. For example, if a person is in a car accident and files a workers' comp claim, the bot could determine if the claimant's automobile insurance could cover the claim. TIMELINESS OF DATA GATHERING AND INPUT Timeliness is a major factor determining when certain pieces of information need to be entered into a claim record. A Ventiv RPA bot can monitor time-sensitive fields and alert adjusters or supervisors if those fields have not been completed within the designated timeframe. MONITOR INBOXES FOR CLAIM-RELATED EMAILS For insurers or TPAs with a general inbox, Ventiv RPA can monitor emails received and be sure those that need to go to the claim department get there. A bot can look for certain words that indicate the correspondence is related to a claim. HOW CLAIM ORGANIZATIONS ARE USING ROBOTIC PROCESS AUTOMATION (RPA) Every claim organizations wants to give its examiners the time and resources to spend more time on claim resolution. Ventiv RPA is a proven technology that automates the time-consuming tasks that get in the way of claim adjudication. Following are RPA use cases specifically for claims administration. For more about Ventiv RPA, visit

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