As data analytics permeate every aspect of the insurance industry, claims management is the next major area to get a technology makeover. It’s one of the most pivotal touchpoints in the customer experience, and simplifying operations is key for customer retention.
The claims process, which involves everything from filing through workflow, includes myriad rules and regulations that typically favor claimants. The best approach to begin streamlining business operations is adopt a technology platform to help automate regulatory requirements that embody every aspect of the claims experience.
When an insurer acknowledges the receipt of the claimant’s report, they’re bound to a deadline (which varies by state) before they must either pay, decline or contest. Further complicating matters, regulators deem claims not fraudulent until proven otherwise. This means insurers must ensure compliance of each state’s regulations and still process claims they expect might be fraudulent. Of the hundreds or thousands claims that could be issued at any moment, technology can help triage them and expedite fraud assessment by detecting fraudulent patterns with artificial intelligence (AI) and machine learning (ML). If there is a red flag of any kind, they now have a digital record to share with regulators who may inquire about the decision-making process at any point in the process.
For triage, insurers traditionally employ a manual validation process for claims which is daunting in terms of time and human capital. Fortunately, technologies like AI and ML also help insurers efficiently run the claimants submission through several databases, such as NCCI, to verify location, weather patterns, and other types of information to expedite background checks. This allows insurers to assign the adjuster best suited for the claim based on its complexity.
Automation can also be used to pre-fill the latest changes from NCCI and other independent bureaus directly into a claims platform, and set up reminders for deadlines and other key regulatory requirements. This helps insurers improve organization of their accounts and consistently reduce the risk of human error.
Clearly, insurers who select modern claims solutions can empower their handlers and adjusters with the best insights in real-time, while avoiding regulatory exposure. To read more about how technology can benefit the claims process you can read my recently published article in Property & Casualty 360.