What is Claims Management Software?

What is insurance claims management software?

At its core, a claims management system is a transaction-enabled system of record that an adjuster or claims handler (or an automated process) uses to:

  • Gather and process information regarding the underlying policy and coverages, the claim, and the claimant.
  • Evaluate and analyse the circumstances of the claim.
  • Make decisions and take actions including payment.
  • Execute transactions and preserve a record.

Who uses claims management software?

Adjusters, assessors and claims handlers have adopted claims management software to better manage their workflow. Traditionally adjusters and claims handlers used a range of manual and paper-based processes. For some business lines in insurance, the claims process still require faxes, paper filing and deciphering clients’ or their doctors’ handwriting. These organisations will have a mixture of digital (seamless) and people powered (manual) data flowing into their claims management system to help manage customer claims.

Advances in technology such as mobile first notification of loss and machine learning have the potential to eliminate time consuming manual processes.

However, before implementing new technologies insurance carriers need to ensure their underlying claims management system supporting their processes is efficient, flexible and capable of introducing advanced process automation.

Why is claims management so important?

For customers, the ‘claims process’ is the moment of truth in the insurance value chain. When customers buy a policy such as car, travel or healthcare, they put their faith in the insurance company to help them in their moment of need. When assistance is required, they expect the claims management department to be responsive, helpful and quick to act and settle their claim.

In fact, many in the industry would argue that ‘The claim is the core product, not the policy’.

From the insurance carrier perspective, building long term relationships with their customers is critical to generating more profit. In recent years insurance companies have started publishing the percentage of claims made that are paid. Jacqueline Kerwood, claims philosophy manager at Aviva UK Life Protection, says building trust is a key reason why Aviva continues to produce such a comprehensive report.

Claims management software helps to make the customer claims experience better by managing claimants data submitted online or over the phone, and enabling handlers to process claims in hours and days rather than months. Reducing the time it takes to settle a claim (turn-around time) is an important way to improve the customers experience. According to EY, 40% of consumers decide to continue their relationship with an insurer based on the quality of that experience.

What does claims transformation mean?

Within the context of insurance, transformation refers to the introduction of digital technologies to create new – or modify existing – claims processes, culture and customer experience to meet the evolving needs of the business.

There a number of reasons insurance companies are rolling out transformation programmes within the important area of claims.

  • Firstly, to keep a pace or outperform competitors who maybe attacking their existing customer base. In recent year, new attackers have leveraged digital technologies resulting in leaner, more transparent and efficient business processes.
  • Secondly, to meet the demands of an increasingly digital savvy customer base. Consumers have quickly adopted digital channels, new smart home features and expect to find a chatbot to help them buy a policy or submit a claim.
  • Thirdly, for the incumbent insurance carriers, to reduce the operational costs associated with maintaining legacy systems, many of which are managing multiple systems inherited during mergers and acquisitions.
  • Fourthly, to reduce fraud in the claims process. In 2019, The Association of British Insurers (ABI) reported that 469,000 fraudulent claims and applications were detected in 2018. British Insurers invest a minimum of £200 million each year to identify fraud.

These drivers have resulted in new company-wide ‘change’ initiatives or transformation programmes to develop an end-to-end digitsation of the claims customer journey.

Is full end-to-end digitization of claims possible?

Digital claims, from claim data input to payment, is the goal for many insurance carriers. Some new insurance carriers are experimenting with a full digital end-to-end journey for specific business lines.

However, for many incumbents, claims handlers are still using manual and paper methods to process claims and communicate with their customers. Some are held back by complex supply chains and regulator constraints. Whilst others are digitising parts of the process first in a stepped journey towards full digitization. Not least, to reassure a proportion of their customers base who may remain hesitant with some digital transactions due to security and privacy concerns.

What technologies are used in claims management?

Claims technologies range from the underlying business process software to a range of point solutions used at different points of the claims process.

For example, at the beginning of the process, chatbot-based FNOL technology allows a customer to submit a claim on the website. The data captured from the chatbot is then routed into the claims platform at the beginning of the claims process. Customers use a variety of channels to submit claims and the claims process platform is ‘agnostic’ retrieving and processing claims via webforms, chatbots, third parties within the claims ecosystem and internal claims handlers.

Similarly, Artificial Intelligence (AI) technology is being used for highly specialised tasks in the claims process. Different areas that AI algorithms are being used to improve different steps in the claims process include; detecting the likelihood of fraud in a claim and segmenting claims cases by complexity so that more complex claims with a higher potential for litigation risk can be routed to the right claims handler.

What technologies are used in Caseblocks Claims Platform?

Caseblocks is a digital claims platform built using adaptive case management software. This adaptive technology results in an easy to use and flexible platform, enabling carriers to digitize some or all of the steps in their process from claim capture to payment.

Caseblocks provides:

  • configurable claims templates such as general insurance, healthcare, fleet, accident and custom claims
  • multichannel FNOL
  • automated claims segmentation
  • machine learning to help drive decision making
  • tools for business users to customise
  • automated claim assessment
  • team-base case decisions
  • integrated case email
  • claims tracking and full audit trails
  • and much more.

These core features are built on a robust platform allowing insurers to create and modify their claims processes to meet the expectations of customers and changing business environment.

In addition Caseblocks leverages new technologies through integration and APIs. These include;

  • Chatbots and mobile first notification of loss (FNOL) to improve the experience of submitting a claim.
  • Robotic process automation (RPA) to reduce time spent on repetitive tasks.
  • Machine learning to improve accuracy and reduce fraud.

To learn more see Caseblocks claims solutions.