Claims Set­tle­ment

Amit Ma­lik, chief peo­ple, op­er­a­tions & cus­tomer ser­vices of­fi­cer at Aviva Life In­surance Com­pany, dis­cusses the com­pany ef­forts to make its cus­tomers feel unique:

Banking Frontiers - - Contents -

N. Mo­han: For an av­er­age in­surance buyer, how cru­cial is the claim set­tle­ment ra­tio? How are In­dian in­surance com­pa­nies in gen­eral im­prov­ing their re­spec­tive ra­tios? Amit Ma­lik:

In­surance is a sig­nif­i­cant in­vest­ment an in­di­vid­ual makes to se­cure the fi­nan­cial fu­ture of his or her loved ones. While a lot of cus­tomers still see in­surance as a tax-sav­ing in­stru­ment, the tribe of fi­nan­cially and dig­i­tally savvy cus­tomers is on the rise, who un­der­stand the im­por­tance of life in­surance as a pro­tec­tion in­stru­ment. It is also quite of­ten an emo­tional de­ci­sion (many buy­ers typ­i­cally look at in­surance once they get mar­ried or be­come par­ents). Claims set­tle­ment ra­tio, there­fore, is one of the most sig­nif­i­cant fac­tors con­tribut­ing to a cus­tomer’s choice of in­surer (if one looks at the ad­ver­tis­ing trends, it can be ob­served that many in­sur­ers now fo­cus on ‘ease and ex­pe­ri­ence of claims set­tle­ment’). There are mul­ti­ple other fac­tors that go into the buy­ing de­ci­sion – the ‘brand’, ac­ces­si­bil­ity and pres­ence, cus­tomer ser vice and com­pet­i­tive pric­ing, etc.

As cus­tomers be­come more fi­nan­cially aware, in­sur­ers are work­ing hard on im­prov­ing their claims set­tle­ment ra­tios. This ra­tio is a de­pen­dent on sev­eral fac­tors - the years of op­er­a­tion of the com­pany, prod­uct mix, per­sis­tency and claims vol­ume among oth­ers. One of the most im­por­tant fac­tors is as­sess­ment of risk and qual­ity at the time of is­suance of the pol­icy. Com­pa­nies are now in­vest­ing in en­hanced due dili­gence to avoid in­stances of fraud. This be­comes even more sig­nif­i­cant with re­cent reg­u­la­tory changes that make it nearly im­pos­si­ble for in­sur­ers to deny claims be­yond a spec­i­fied time limit (also lead­ing to bet­ter claims ra­tios). An­other fo­cus area is to make the sell­ing process as trans­par­ent as pos­si­ble to en­sure that cus­tomers know the prod­uct and the con­tract.

Can you ex­plain how easy or how dif­fi­cult it is for a claimant to have the claim set­tled? What is the ex­act process?

We are ob­sessed with ‘killing com­plex­ity’ and be­ing a ‘cus­tomer first’ or­ga­ni­za­tion. Claims set­tle­ment is the mo­ment of truth for any in­surance com­pany. For us at Aviva, it is an op­por­tu­nity to stand with and em­pathize with our cus­tomers in their mo­ment of grief. Hence, we have a claims set­tle­ment process that is sim­pli­fied and ex­tremely user friendly. The mo­ment a cus­tomer reg­is­ters a claim re­quest, our peo­ple, whether they are branch ser­vice ex­ec­u­tives or claims team mem­bers, make it their duty to help the cus­tomer in ev­ery step of the jour­ney. For claims that do not re­quire any in­ves­ti­ga­tion, we set­tle 98% of cases within 7 days from re­ceipt of com­plete set of doc­u­ments against 30 days’ time­line al­lowed by the reg­u­la­tor. Even for cases that re­quire in­ves­ti­ga­tion, we ad­here to the reg­u­la­tory time­frame in 100% of the cases.

Fur­ther, Aviva has in­sti­tu­tion­al­ized the ‘30 Minute Claim’ process wherein up to spec­i­fied lim­its, we en­deavor to set­tle gen­uine claims and hand over a set­tle­ment de­ci­sion let­ter to the cus­tomer within 30 min­utes of the cus­tomer ap­proach­ing us and shar­ing the re­quired doc­u­men­ta­tion. This ‘over the counter’ claims set­tle­ment process was a first and now is one of its kind in the life in­surance busi­ness in In­dia.

What is spe­cial about the com­pany’s ef­forts in dis­burs­ing un­claimed funds?

We take pride in be­ing a ‘Cus­tomer First’ or­ga­ni­za­tion. In the past 3 years, sev­eral in­no­va­tive mea­sures have been taken for the dis­burse­ment of un­claimed funds. One of the big­gest rea­sons for un­claimed funds is cus­tomers not be­ing con­tactable. We had set up a ded­i­cated team in 2017 to tackle this prob­lem. The team has reached out to cus­tomers us­ing tra­di­tional com­mu­ni­ca­tion means like SMS, calls and emails. They have also taken ex­traor­di­nary steps like skip-trac­ing via busi­ness list­ing chan­nels and credit bureaus, so­cial me­dia tools like LinkedIn and Face­book to reach out to cus­tomers. A re­cent ex­am­ple of our com­mit­ment to in­no­va­tion and cus­tomer ser­vice has been a project where the cur­rent bank de­tails of cus­tomers who were not con­tactable were ver­i­fied us­ing a oneru­pee IMPS trans­fer. This helped us in com­plet­ing un­claimed pay­ments to many cus­tomers. Th­ese ef­forts have helped us in trans­fer­ring more than `1.4 bil­lion to cus­tomers from un­claimed funds.

Are claim set­tle­ments in the com­pany fully au­to­mated? Can you de­scribe the sys­tem? What is the tech­nol­ogy that is be­hind the process? For a cus­tomer, how seam­less an ex­pe­ri­ence it is?

The process is au­to­mated but not free of hu­man in­ter­ven­tion. While there are newer en­trants in the gen­eral in­surance mar­ket (abroad and now also in In­dia) us­ing tech­nol­ogy to au­to­mate the set­tle­ment process (some­times end-to-end), com­plete au­to­ma­tion in the life busi­ness is yet to be­come a re­al­ity owing to com­plex­i­ties. The claims set­tle­ment process at Aviva is, how­ever, com­pletely seam­less.

A cus­tomer can reg­is­ter a claim at web­site, by call­ing or writ­ing to our cus­tomer ser­vice team or by walk­ing into any of the Aviva branches. The rel­e­vant forms and guide­lines to fill up the same are avail­able on the com­pany web­site. From the stage of claim in­ti­ma­tion till when a de­ci­sion is taken, the cus­tomer gets pe­ri­odic up­dates via SMS and email about the sta­tus of their re­quests. The claimant can also check their claim sta­tus any­time through a login­based cus­tomer por­tal on Aviva web­site or from a per­son­al­ized claims man­ager. Once the claim is ap­proved, the claim amount gets elec­tron­i­cally trans­ferred to the claimants’ ac­count.

How do you de­tect or iden­tity fraud­u­lent claims? Is the sys­tem equipped to throw trig­gers? Do you make use of AI in this ef­fort?

Iden­ti­fi­ca­tion and mitigation of fraud be­gins at the stage of ac­quir­ing new cus­tomers. We have sev­eral checks and bal­ances to en­sure that any new busi­ness is of the high­est qual­ity. We also have a ded­i­cated risk con­trol unit which per­forms en­hanced due dili­gence where nec­es­sary. Our his­tor­i­cal claims data and ex­pe­ri­ence plays a sig­nif­i­cant role in build­ing checks or red flags at the busi­ness ac­qui­si­tion stage. This in­volves steps like KYC ver­i­fi­ca­tion, em­ployer check and phys­i­cal ver­i­fi­ca­tion among oth­ers.

At the claims stage, an ex­pe­ri­enced claims team eval­u­ates each case on its merit. We also part­ner with or­ga­ni­za­tions that spe­cial­ize in in­ves­ti­ga­tions and fraud in­ves­ti­ga­tions. There is reg­u­lar study of data for any early warn­ing signs of fraud.

While we do have pro­grams/ mod­els to help us iden­tify cases that war­rant ad­di­tional checks, we are still in early stages of eval­u­at­ing pos­si­ble us­age of AI in this do­main.

Aviva is known for its cus­tomer ed­u­ca­tion pro­grams. Can you give some high­lights?

As a brand that truly wants to make a real dif­fer­ence to its cus­tomers, we have made it our so­cial brand pur­pose to in­crease the level of fi­nan­cial lit­er­acy in In­dia. We have taken it upon our­selves to make In­di­ans more aware about the im­por­tance of fi­nan­cial plan­ning for dif­fer­ent var­i­ous lifestage needs. As a Dig­i­tal First or­ga­ni­za­tion, we have gone above and be­yond the call of duty to of­fer truly in­no­va­tive, cus­tomer cen­tric tools that en­able cus­tomers to ful­fill their life goals. Be­low are some ex­am­ples:

ALEXA Skill: We launched an Alexa skill, In­surance Made Sim­ple, to sim­plify life in­surance jar­gon and to pro­mote fi­nan­cial lit­er­acy

So­cial Me­dia Cam­paigns and Blogs: Fi­nan­cial lit­er­acy cam­paigns to in­crease aware­ness about fi­nan­cial terms, such as a re­cent cam­paign called ‘Dhan­hit Mein Jaari’, aim to ex­plain fi­nan­cial terms in a fun and sim­ple way to ed­u­cate and en­gage the au­di­ence.

Kid-o-Scope is a dig­i­tal ecosys­tem in part­ner­ship with ex­perts, doc­tors and child psy­chol­o­gists to en­able users to catch the early signs of in­her­ent ta­lent shown by the child.

Will Writ­ing: The Aviva ‘Will Writ­ing Ser­vice’ helps cus­tomers cre­ate a Will for their as­sets, in just 3 sim­ple steps in just 15 min­utes!

Apart from the above truly in­no­va­tive of­fer­ings, we also reg­u­larly com­mu­ni­cate with cus­tomers to make them aware about fi­nan­cial frauds and how to mit­i­gate the same.

What are the plans ahead in terms of fur­ther im­prov­ing cus­tomer ex­pe­ri­ence?

We are cre­at­ing in­no­va­tive dig­i­tal propo­si­tions and plat­forms to carve out a dif­fer­en­ti­ated niche for our­selves to be­come more rel­e­vant to to­day’s cus­tomer. Our fo­cus re­mains on im­prov­ing ev­ery as­pect of the cus­tomer jour­ney, right from pur­chase to claims. Some as­pects of the same are:

Mo­bile Sales Tool: an end to end sales en­able­ment tool that cap­tures the en­tire sales jour­ney on­line. For the cus­tomer, it means do­ing away with com­pli­cated pa­per­work, faster ful­fil­ment and a seam­less ex­pe­ri­ence.

Ser­vice side –AI BOT – ALISHA ( Avi v a Li f e Ins ur a nc e Sel f - Help

As­sis­tant): Pow­ered by IBM Wat­son, this BOT helps cus­tomers in as­sess­ing the fi­nan­cial need and guides by ei­ther of­fer­ing a quote or con­nect­ing to an agent, start­ing off the buy­ing process.

MyA­viva is our cus­tomer por­tal of­fer­ing self-ser­vice op­tions. Half of the con­sumer base is al­ready reg­is­tered on­line. 75% of them will trans­act ev­ery year at least once on­line. More than 50% of the ser­vice re­quests come through the cus­tomer por­tal – My Aviva. We are con­tin­u­ously work­ing to re­vamp its ca­pa­bil­i­ties to of­fer more to cus­tomers.

Live Chat: We are work­ing on build­ing this ca­pa­bil­ity as an al­ter­nate mode of ser­vic­ing cus­tomers

Amit Ma­lik de­scribes claims set­tle­ment in Aviva Life In­surance as an op­por­tu­nity to stand with and em­pathize with its cus­tomers in their mo­ment of grief

Aviva’s Alexa Skill

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