Digital Insurance - - CLAIMS - Boyd Fittes, Vice Pres­i­dent, Prod­uct Man­age­ment, StoneRiver – a Sapi­ens com­pany

From 2003 – 2010, many new claim sys­tems were de­ployed that in­cluded some con­fig­u­ra­tion ca­pa­bil­i­ties and even some work­flow. How­ever, strong claim sys­tems of the early 2000’s have hit snags to do­ing busi­ness to­day, caus­ing car­ri­ers to con­sider next steps. Should they in­vest the time and ef­fort in a ver­sion up­grade and en­dure what is, in ef­fect, the de­ploy­ment of a new sys­tem?

Con­sumer ex­pec­ta­tions have ex­ploded in the past five years, and the pace of change has ex­posed the ear­lier sys­tems’ lim­i­ta­tions. Claim ad­min­is­tra­tion sys­tems to­day need to fo­cus on em­pow­er­ing:

• Im­proved de­ci­sion mak­ing across the life cy­cle of a claim. This can be ac­com­plished with a com­bi­na­tion of rules and work­flow to au­to­mate de­ci­sion mak­ing and trig­ger tasks to the cor­rect de­ci­sion maker when needed. Ex­am­ples in­clude re­duc­ing over­all ex­po­sures from cov­er­age ver­i­fi­ca­tion/limit check­ing, fraud­u­lent be­hav­iors of claimants/ ven­dors, or keep­ing ahead of reg­u­la­tory re­quire­ments.

• Im­proved cus­tomer ser­vice for pol­i­cy­hold­ers and claimants. Look for sys­tems hav­ing cen­tral­ized man­age­ment of cus­tomer/ven­dor in­for­ma­tion, in­clud­ing a 360-de­gree view of how they are in­volved with your oper­a­tion.

“One click” ac­cess to their data helps en­sure re­spon­sive cus­tomer sup­port calls. Ser­vices for email and text mes­sag­ing for com­mu­ni­ca­tion with ad­justers, man­agers, pol­i­cy­hold­ers/ claimants and ven­dors en­able prompt staff ac­tions. Your cus­tomers can be in­formed – in a mod­ern way – through­out the life of the claim. Plus, pro­vid­ing sim­ple, tech­ni­cally ad­vanced self-ser­vice ca­pa­bil­i­ties is para­mount.

• In­creased agility, flex­i­bil­ity and re­ac­tion in the claims op­er­a­tions. Mar­ket con­di­tions are chang­ing as well as pol­i­cy­holder/agent ex­pec­ta­tions and ven­dor ca­pa­bil­i­ties. If your claims oper­a­tion can re­act quickly to such forces, your or­ga­ni­za­tion is on its way to stay­ing com­pet­i­tive. An­tic­i­pat­ing the “change tsunami” now un­der­way in the P&C mar­ket, StoneRiver in­vested in an ar­chi­tec­tural frame­work and ser­vice-ori­ented ar­chi­tec­ture and used a highly con­fig­urable ap­proach through meta-data and rules.

The re­sult? Car­ri­ers gain an abil­ity to change rapidly (hours or days rather than weeks), whether it’s:

• Adding a value in a drop-down • Adding a new data el­e­ment on a screen • Adding a busi­ness rule • Adding a work item/note/doc­u­ment tem­plate for a chang­ing work­flow

• Re­plac­ing a third party ven­dor ser­vice/interface, or • In­tro­duc­ing a new line of busi­ness

• Im­proved pro­duc­tiv­ity and re­duced op­er­a­tional costs. Us­ing work­flow and as­sign­ments to en­sure con­sis­tent work­flow and pro­cesses across the claims or­ga­ni­za­tion im­proves pro­duc­tiv­ity and in­ter­nal ex­penses. In ad­di­tion, us­ing mod­ern tech­nolo­gies and a “con­fig­u­ra­tion first” ap­proach to sup­port more flex­i­bil­ity and lower cost when re­act­ing to chang­ing busi­ness needs re­duces re­liance on ex­pen­sive IT re­source and an­ti­quated tech­nol­ogy.

• Im­proved data ac­cess to en­sure that staff, man­agers, and su­per­vi­sors have the in­for­ma­tion they need to run an ef­fec­tive oper­a­tion and to en­sure that in­for­ma­tion is re­li­able. To­day’s claim sys­tems in­clude op­er­a­tional data store and change track­ing, stan­dard re­ports, KPIs, dash­boards and ad-hoc re­port­ing specif­i­cally fo­cused on the P&C in­dus­try.

• Mod­ern­ized, in­tu­itive user interface, which is con­fig­urable through rules, to im­prove the over­all user ex­pe­ri­ence and ef­fec­tive­ness. In­tro­duc­ing a con­sis­tent, sim­pli­fied method to nav­i­gate and pro­vid­ing the user with the abil­ity to multi-task without los­ing data pro­vides for op­er­a­tional ef­fi­cien­cies. Giv­ing in­di­vid­ual users the abil­ity to set up their work views as they see fit for their spe­cific role just en­hances this ef­fi­ciency. A “num­ber of small things add up to big im­prove­ments” is what we have heard from those fa­mil­iar with the new Stream® user interface. More­over, keep­ing the nav­i­ga­tion sim­ple and con­sis­tent al­lows for a rapid and easy on­board­ing of new staff or the re­al­lo­ca­tion of staff to sup­port catas­tro­phe sit­u­a­tions. Con­sis­tency breeds pro­duc­tiv­ity.

If th­ese six ar­eas ad­dress your or­ga­ni­za­tion’s ob­jec­tives, it might be time for a claims ini­tia­tive. Whether you’re look­ing at a claims ini­tia­tive next year or fur­ther out, be sure to con­sider what good tech­nol­ogy should do.

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