Much of this claims growth is due to programmatic fraud: more than 80 million claims submitted in 2023 showed significant signs of fraud, representing a 19,000% increase from just two years earlier, according to recent reports. Fraudsters are exploiting the vulnerabilities in claims submission systems, using sophisticated programs to flood the process with fraudulent claims.
Now, not only must claims administrators be prepared to process the rapid submission of claims, up to 10+ claims per second, they must also be able to validate large volumes of claims comprehensively, in one data set. Unfortunately, these large volumes of claims mean that traditional data tools are no longer suited for effective claims administration.
Why Traditional SQL Databases and Tools Fail
Many administrators rely on industry-standard spreadsheet software, such as Microsoft Excel or Google Sheets, for their reviews. However, these tools have inherent limitations that can impede the accuracy and efficiency of claims administration when the volume exceeds their capacity.
Both Excel and Google Sheets have row limits of roughly 1 million rows per file. This presents a significant challenge when handling bulk claims, which are typically stored in SQL databases. Since administrators cannot visually review claims in bulk within SQL databases, they must export the data into Excel or similar software to conduct their analysis. But when the volume exceeds one million claims, administrators are forced to split the data into multiple files, leading to disjointed and inconsistent reviews.
This data fragmentation creates a breeding ground for errors, particularly in cross-claim evaluations, where comprehensive data visibility is essential.
The Impact of Duplicate Claims
ClaimScore uncovered a significant issue during a recent review: more than five million claims were submitted, many of which contained duplicate entries or aliases. The administrator, relying on Excel, had split the claims into multiple files for review. Since the duplicates were spread across different files, they were not easily identified. This resulted in the inadvertent approval and payment of duplicate claims, ultimately reducing the payout available to other class members. The inability to see the entire dataset at once led to a costly mistake that could have been avoided with better tools.
This situation illustrates why it’s essential for claims administrators to have systems in place that can handle large volumes of claims beyond the capacity of spreadsheet software. Claims administration requires precision, especially when managing high volumes of data. Tools that can process large datasets without fragmentation are key to ensuring that duplicate claims, fraudulent submissions, and other discrepancies are caught early in the review process. By relying on solutions like ClaimScore, administrators can benefit from advanced technology designed specifically for high-volume claims, eliminating the need to split data across multiple files.
A Solution for Validating Large Claim Volumes
Beyond handling large datasets, ClaimScore offers powerful data validation and review capabilities that go far beyond what Excel or Google Sheets can offer. These tools ensure that administrators can catch errors, duplicates, and other inconsistencies with ease, safeguarding the integrity of the claims process. By streamlining data review and flagging potential issues before they result in financial losses, ClaimScore not only protects administrators but also ensures fairness and accuracy for all class members.
As claim volumes continue to grow and data complexity increases, it’s vital that administrators recognize the limitations of traditional data tools. While these tools are effective for smaller datasets, they simply cannot keep pace with today’s demands. To ensure a smooth, accurate, and fair claims process, administrators must adopt more robust technological solutions that can process and review large volumes of data efficiently, without compromising on accuracy. ClaimScore’s advanced platform provides this capability, ensuring that administrators can handle even the most complex claims reviews with confidence and precision.
By using the right tools, administrators can avoid the pitfalls of duplicate payments and other costly mistakes, ultimately enhancing the efficiency and integrity of the claims process.
To learn how to build a successful class action settlement, check out our new ebook, ”Best Practices in Class Action Claim Validation: A Checklist.”
