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Properly Managing Insurance Claims

Historically, the insurance industry saw claims simply as an obligation, and not as a means of strengthening loyalty and improving retention rates. As a result, the industry struggles with establishing meaningful relationships with policyholders. Policyholders expect first-rate customer experiences from their insurer providers, and a seamless claims process is integral to such an experience. Therefore, offering a superb claims experience is an enormous competitive advantage.

Claims As An Opportunity

Many insurers make the mistake of using outdated technology to handle claims processes, which rely on time-consuming manual tasks.

The aim of an insurance claims process is to reduce expenses and fraud while improving customer satisfaction by fostering authentic relationships with claimants.

Understanding Insurance Claims Management

Insurance claims management is a multi-step process designed to provide claimants with assistance while protecting the insurers from paying out fraudulent claims:

  • The notice of claim from the claimant is received.
  • Determine up to what amount the loss is insured.
  • Collecting relevant documents such as police reports of car accidents and medical results.
  • Establish the cost of the claim and make sure that the claim isn’t fraudulent.
  • Indemnify the claimant.

Once all the necessary information is collected, then the insurer needs to move the claim along quickly and reach the right decision.

What Do Claimants Expect?

Policyholders expect a quick reaction after they file a claim. Providers should instantly acknowledge claim filings and request contact details and relevant data.

For complicated cases, carriers should ensure that their staff reaches out to claimants to discuss the next steps.

A Fast Claims Experience

Compensating policyholders is just one (admittedly the most important) feature of a claims management process. The process starts when a claim has been filed. The next steps ensure both that the claim is valid and the amount the insurer is required to pay.

Since a quick claims settlement process means a higher customer retention rate, insurance carriers need to streamline this process to acquire a competitive advantage.

Taking the Initiative

Insurers should take charge and anticipate claimants’ needs.

For instance, an insurance company could have rules that notify the claimant that a series of required treatments haven’t been completed.

Preventing Fraudulent Claims

Paying out fake claims eats into carriers’ bottom line, which is an expense passed on to policyholders.

A business rules engine is the best way insurers can identify fraudulent claims in real-time.

An insurer can use business rules to analyze payment transactions and spot trends in claim reimbursements in order to fight fraud.

For example, the number of times the same policyholder has filed a claim can serve as an indication of fraud.

Rules Engines Behind Claims Management Software Solutions

Rules engines are an essential software tool because they enable insurance carriers to:

  • Streamline the claims management process by speeding up the claim routing with business rules. Therefore, the right claim goes to the appropriate adjuster in the claims department of the insurer.
  • Enhance existing workflows by making sure that non-technical staff members manage claims management without relying on support from the IT department.
  • Accelerate the claims process so that claimants received reimbursement as quickly as possible.

Therefore, carriers can easily manage claims — from notice of loss to full reimbursement.



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