A claim is a critically important time for an insurance company — it’s an opportunity to hold up their end of the contract and act promptly. Historically, the insurance industry thought of claims solely as an obligation, and not as a way of building relationships with policyholders and boosting retention rates. In the saturated insurance industry, providing a hassle-free claims experience is an important differentiator.
What is Insurance Claims Management?
There are many different steps in an insurance claims management process:
- Obtaining the notice of claim.
- Determining whether the loss is covered by the insurance plan.
- Requesting supporting documents such as images of damaged property.
- Making sure that the claim is not fraudulent.
- Making the necessary repairs.
- Reimbursing the insured party.
Once all the necessary information is obtained, then it’s up to the claims department to move the claim along and make the right decision in a timely manner.
What Do Policyholders Want?
Policyholders expect insurance carriers to promptly act once they’ve been notified of a loss.
Unfortunately, many insurers still rely on manual tasks to handle their claims processes and pay minimal attention to customer satisfaction. This means that settling the claim is a long-drawn-out process and policyholders have to wait for help from their insurance companies.
Accelerate Claims Handling
Policyholders who file claims need to settle claims quickly and fairly.
Given that quick claims settlements mean higher customer satisfaction levels, insurance companies can get an edge over the competition by speeding up the claims process.
The Human Touch is Still Important
Despite major advances in AI, human adjusters will continue to play a vital role in the claims management process. Using business rules engines, the claims management department be able to work more effectively while still showing real human empathy to the policyholders.
Generally, complex claims require human attention and judgment.
Rules engines can help insurance companies to approve straightforward claims with predictable characteristics. This enables the claims department to focus on more complicated cases that require nuance.
A business rules engine drastically shortens the claims-processing times while providing robust claims management.
Be Proactive
Insurance carriers must be able to anticipate and meet policyholders’ needs.
Insurers that communicate with policyholders by relying on business rules to anticipate their needs will cut down on the number of non-essential calls to the claims departments, which improves the customer experience.
Flag Fake Claims
The insurance industry is one of the hardest-hit sectors by fraud globally. Clearly, paying for fake claims greatly hurts the bottom line of insurers. Naturally, this expense is passed on to the insureds.
Fighting Fraudulent Claims
A tried and tested method of spotting fake claims in real-time is with a rules engine.
For example, an insurer can use rules to analyze payment history and spot trends in claim payments to help the carrier identify fraudulent claims.
A fraud prevention solution that’s powered by rules improves the settlement process by reducing the likelihood of paying out fake claims.
Optimizing Insurance Claims Management with Rules Engines
Insurance carriers can easily manage the entire claims lifespan with a business rules engine— from first notice of loss to reimbursement. Rules engines can be configured to optimize the decision-making processes of insurance companies.
A business rules engine ensures that the right type of claim goes to the relevant employee in the claims department. As a result, the claims process takes much less time and policyholders are swiftly paid.
