Business Process Management (BPM) systems play a pivotal role in ensuring efficiency and accuracy in Claims processing. However, as technology advances and work environments evolve, it is essential to evaluate whether your current BPM system is meeting the demands and challenges of modern claims processing. In this article, we will explore five common gaps that may be impeding the operational efficiency of your claims processing system, along with actionable insights and solutions to address these challenges.

Limited Visibility in Remote Work Environments

In today’s increasingly remote work landscape, having visibility into work processes is crucial. Traditional BPM systems often fall short of providing a comprehensive picture, particularly when dealing with dispersed teams and functions. The lack of transparency makes it challenging to understand how employees spend their time across different groups. To overcome this gap, organizations need a forward-thinking solution that offers real-time data on employee activities. This ensures that the claims processing workflow remains agile and adaptable, regardless of the location of employees.

Breaking Down Silos for Holistic Operations

Efficient claims processing requires seamless collaboration across various teams, functions, and systems. However, information silos can hinder the flow of data, leading to inefficiencies. Traditional BPM systems typically follow a first-in, first-out approach to processing work items, which may contribute to siloed operations. To overcome this challenge, organizations should adopt an operational dashboard that integrates data feeds from different processing systems. This holistic view provides insights into work volumes, handle times, and employee availability, breaking down silos and fostering collaboration.

Meticulous Resource Capacity Planning for Efficiency

Resource capacity planning is a critical aspect of efficient claims processing. Traditional BPM systems may struggle to accurately forecast demand, understand resource availability, and factor in backlog. To ensure operational efficiency, organizations must develop comprehensive capacity plans that consider various variables, including work types, volumes, SLAs, employee skills, and backlog. Failing to incorporate all these variables can result in either overstaffing or understaffing, compromising claims processing efficiency. Robust BPM solutions empower organizations to create accurate capacity plans aligned with their specific claims processing requirements.

Real-time Adaptability: A Crucial Aspect Against SLAs

Even with a well-crafted capacity plan, unforeseen circumstances can disrupt claims processing operations. Traditional BPM systems often face challenges in real-time re-balancing of work against service level agreements (SLAs) or service goals. Whether it’s a sudden surge in workload or unexpected downtime, the ability to adapt in real-time is paramount. Innovative BPM solutions offer real-time mission control that enables automated or manual reprioritization of work items. This ensures that service goals are consistently met and claims processing remains agile in the face of uncertainties.

Embracing Workforce Flexibility for Optimal Scheduling

The workforce landscape has evolved, with employees seeking increased flexibility in their schedules. Rigid scheduling enforced by some BPM systems may not align with the changing preferences of today’s workforce. To optimize schedules and enhance productivity, organizations need solutions that can generate flexible schedules based on workload, employee skills, availability, and preferences. This flexibility enhances operational efficiency and creates a more satisfied and engaged workforce.


Evaluating the performance of your BPM system in the context of claims processing is essential for achieving operational excellence. By addressing the potential gaps outlined in this article, organizations can streamline their claims processing workflow, making it more adaptive, efficient, and responsive to changing demands. Stay tuned for our upcoming blogs, where we will delve deeper into each of these challenges, providing further insights and actionable solutions for building a more effective claims processing system.