Understanding Insurance Claims Management

When an insurance claim is filed, the insurance company has to hold up its end of the bargain and step up. It is in their time of need that policyholder holders need a swift reaction from their insurer. Policyholders need exceptional customer service, and an insurance claims procedure is vital to providing such an experience.

Rethinking Insurance Claims Management 

Recent surveys show a sharp surge in the rate of complaints from policyholders regarding slow claims procedures. For this reason, it’s important that the process is designed for an exceptional insurance claims experience.

Defining Claims Management

We’ve outlined all the important steps involved in an insurance claims management process below: 

• Accepting the notice of claim from the policyholder regarding damages or a loss.
• Determining whether the damage is covered by the policy. 
• Receiving supporting files such as police or medical reports.
• Determining whether the claim is fake.
• Reimbursing the insured.

Once a claim has been made, it’s up to the insurer to reach an appropriate decision quickly. 

Expectations of Policyholders

Claimants want a fast response from their insurers after they file a claim. Insurance providers need to acknowledge the claim instantly and request the necessary documents.

Streamline Claims Management

Reimbursing insureds is only one feature of the claims process. The procedure begins with the claim being filed. The following stages demonstrate whether a claim is legitimate and the amount the provider will pay. 

Since speedy settlements significantly boost the customer experience,  insurance carriers can enjoy a competitive edge by enhancing the claims process.

Empathy is Important

Despite major technological innovations in various branches of artificial intelligence, software applications will never be able to replace human empathy; human adjusters will continue to have a vital role in claims management. 

This is why many insurers use rules engines. A business rules engine is a sophisticated but user-friendly piece of software that runs algorithms created by conditional statements known as business rules.

These business rules help streamline the claims process by ensuring that each criterion has been met, freeing up the insurance agent to focus on areas that require nuanced judgment. Also, it enables human adjusters to show real empathy instead of being overwhelmed with paperwork.  

Proactivity is Key

Insurance carriers should anticipate claimants’ needs. For instance,  the insurer should explain what the next steps will be or keep the claimant updated on the status of the claim.

Insurers that communicate with claimants by using rules engines to anticipate their needs will cut down the number of unnecessary calls, text messages, or emails to the claims departments, which is important for enhancing the customer experience. 

Identify Fraudulent Claims

It goes without saying that paying out fraudulent claims hurts the insurers’ bottom line. At the end of the day, this expense is paid by the policyholders in the form of more expensive insurance coverage and a more strict underwriting process. 

Managing Claims with the Right Software

A business rules engine empowers insurers to streamline the claims process by accelerating claim routing. Therefore, the right type of claim is handled by the right to the human adjuster or employee.