Infographic: What’s Your Weak Link in Claims Adjudication?
Why Claims Adjudication Matters More Than Ever
For health plans, claims adjudication is more than just a back-office function — it’s a core driver of member satisfaction, provider trust, compliance, and financial performance. Yet many payer organizations struggle with bottlenecks, errors, and outdated processes.
Weak spots can ripple across the entire health plan: slowing turnaround times, creating audit risk, or damaging provider relationships. To truly optimize claims adjudication, plans need strength across multiple areas — not just speed.
That’s why we created this quick reflection tool. The infographic below highlights five essential areas of adjudication performance. As you review each “link” in the chain, consider where your organization is strong and where improvement opportunities may lie.
Five Areas Every Heath Plan Must Get Right
The infographic breaks down claims adjudication into five critical areas:
Turnaround Time (TAT): How quickly clean claims are processed.
Accuracy & Integrity: The ability to prevent underpayments, overpayments, and fraud.
Operational Agility: How effectively you scale staff or adapt to policy changes.
Technology & System Integration: Visibility into real-time performance and connected workflows.
Proactive Performance Improvement: Using regular reviews to drive continuous optimization.
Each of these areas is interconnected — and your claims operation is only as strong as its weakest link.
Why Reflection Isn’t Enough
Identifying your weak links is a powerful first step, but it’s only the beginning. Claims adjudication doesn’t exist in isolation; it connects to intake, compliance, member communications, and the entire payer lifecycle.
Optimized health plans use automation-ready data, technology-enabled workflows, and scalable operations to strengthen every link in the chain. Imagenet’s adjudication services deliver:
>98% accuracy to reduce costly rework and provider abrasion
24–48 hour clean claim turnaround times (vs. 15-day averages)
Scalable surge capacity without operational disruption
Audit-ready processes that minimize compliance risk
When adjudication improves, the entire claims lifecycle improves.
Go Deeper with the Claims Self-Assessment
The infographic offers a snapshot — but if you want to see where your plan truly stands, the full Claims Adjudication Self-Assessment provides a structured way to measure performance and benchmark against industry standards.
With targeted questions and scoring, the tool helps you:
Identify gaps across all five areas of adjudication
Prioritize where to focus improvement efforts
Build a roadmap for stronger health plan operations
Ready to see how your plan stacks up?