It's time to bring claims departments into the modern era with new technology, writes
Let us look at these areas in more detail.
Notification
Notification of a claim is critical as this will initiate the journey. The information gathered and entered into a case file can be triaged by a high-level rules base. This will determine, without the involvement of a claims assessor, what further information is required, such as a tele-interview or a nurse visit. With the customer still engaged at the notification stage, the insurer can offer him or her access to their own case file via a secure online portal. The customer can also book a tele-interview or nurse visit appointment.
Initial Evidence
Tele-interview scripts and nurse reports are designed to capture data with less subjective detail. The use of digi-pen technology provides unprecedented reporting turnarounds and records the data in a format suitable for interrogation and management reporting.
Technical resource
Once the evidence is returned, the claims assessor is prompted to access the case file to commence the assessment process, thus optimising time management. Should the assessor’s authority level exceed the agreed threshold or should he or she welcome the reinsurer’s views on a case, the reinsurer is automatically invited to access the case file in order to review the evidence and record a suggested approach.
Medical Evidence
A menu of services (GP and treating consultant reports, insurance medical examinations, physiotherapy, counselling and funcational capacity evaluations) held at case file level are available for the claims assessor to instruct and manage the costs by requesting regular updates.
Customer Journey
All stakeholders, whether end customer (claimant), intermediary or employer, are provided with appropriate access to the case file. This will allow the insurer to automate relevant communications being sent out in a timely fashion. Other services may be offered to the customer, which go beyond the claims decision. Taxi services, second opinions and support counselling services should all be considered, as should maintaining an interaction with customer after the claim has been paid.
Management Information
The process must be designed so that every possible variable is recorded and formatted to feed management information reports. Touch-point analysis, evidence requests, medical fee expenditure, fulfilment costs, outcomes, quality control procedures and compliance should all be managed from the sourced data.
This kind of system is valuable not only to the time- and data-starved claims department, but to business units right across the company. Marketing will be able to interact with the customer base via an online platform and analyse patterns of behaviour to inform future strategy. Actuarial, finance and investments will be able to use data gathered via the system to inform risk profiles, product development, processing costs and business opportunities.
Of course, the benefits extend outside the business, too – to the consumers. The need to transform the claims process into a customer journey has been well-documented by many industry experts. The payment of a claim is a given, but how the insurer and the customer interact is key.
Publishing a 95% claims payment ratio does nothing to address the customer journey, nor does it provide us with evidence that a life office is satisfying the code of practice of ‘treating customers fairly’.
There is more to be gained by addressing the reasons why the 5% of claims were not paid and to do this within a dynamic and robust claims process that manages the claimant’s expectations from the claims notification stage through to a decision and beyond.
For those lump sum payments, the customer experience could influence whether the money is reinvested with the insurer or with a third party. This would suggest a correlation between the customer’s journey and maximising business opportunities while achieving higher rates of retention. Surely, no further incentive is required to focus management’s efforts in addressing these opportunities.
While waving a magic wand isn’t a realistic option, the flexible, web-based technology needed to embrace the ‘Age of Data’ is now available through companies such as Medicals Direct. For those people who work in claims, the hope must be that the next Attitudes survey paints a more positive picture of the future of this critical department.
Richard Freeman is business development director at Medicals Direct Group
