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:
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