Modernizing the Property & Casualty Claims Process in Insurance

How can intelligent process automation benefit the insurance industry? One area that I thought might resonate with many of you is the critical function of claims processing – a fundamental component of any insurer’s operation.

Read my earlier blog postfocused on how insurers can drive both revenue and an amazing customer experience.

To set the background for this post, let’s look at how claims are traditionally processed.

Traditional Claims Processes

When an insured party contacts their insurer through a dedicated support line to make a claim on a policy, the following typically occurs:

  • The claimant calls the claims support line;
  • Their identity and insurance coverage is verified by the support agent;
  • The responding agent collects pertinent information relevant to the incident;
  • A deeper investigation may be employed to best gauge the situation;
  • The claim is verified and either paid or denied;
  • The claimant can potentially appeal the decision.

This is a convoluted process that takes substantial time and effort on the part of the claimant and the insurer.

The Challenge with This Claims Process

Considering the costs of the support agents’ time, the often-complex procedures of investigating an incident, and working with a wide assortment of parties, each claim is a potentially expensive proposition.

To add to the complexity, the claims process can often be a “make it or break it” moment. If the claim proceeds flawlessly, the claimant will be satisfied with their insurer. If the process does not meet their needs, however, the company could potentially lose their business.

Factors that complicate the process:

  • Working with numerous parties
  • Minimal visibility for claimants
  • Potential for fraud
  • Working with incomplete or insufficient data
  • Potential for additional costs and a poor client experience

So how could this be improved? The Nintex Platform can step in to help you manage, automate, and optimize the process.

Claims Processing 2.0

To create a better experience for all parties, let’s run through a scenario highlighting the impact of process automation on the claims process.

This example could easily be customized to meet specific organizational needs or connect with additional systems or stakeholders.

insurance claims nintex

The Nintex Scenario

Mira, a claimant, calls her insurer to start the claims process after an accident seriously damaged her home.

The responding support agent immediately answers the phone and instructs Mira to complete a claims form, which is automatically sent to her during the call. It is a simple, short form which is browser-based and accessible on any device.

Mira completes the form and easily uploads photos of the damage via her smartphone. The process takes minutes, and Mira is able to provide details and supporting materials about the accident on her terms.

For the insurer, this means less time is spent on the phone with the support agent, which helps mitigate cost per claim.

Once submitted, the process automatically verifies whether Mira’s policy is valid, and conducts an intelligent risk assessment. Leveraging the power of machine learning, the claim is compared against similar incidents and assigned a risk level of either “normal” or “high.”

If a higher risk score is assessed, an investigator would be assigned to probe the claim further and potentially reduce the chance of fraud. Claims leakage is minimized, and the system learns how to better predict the best workflow route the next time a similar situation arises.

Throughout this entire process, Mira is alerted via text messages when her claim moves to a new stage, which provides her with a much-appreciated level of transparency.

The workflow now evaluates the optimal payment path: Settle the claim outright (to minimize any unnecessary steps), or initiate further settlement negotiations. In Mira’s case, the payment is approved outright and sent for processing.

She receives the necessary funds to repair her property and the claim data is further used for audit purposes.

Next Steps

Now that we’ve looked at how intelligent process automation can improve the world of claims processing, imagine what could be done when it is applied to other key insurance scenarios, such as application processing, underwriting, or even customer self-service.

What would your organization look like when it has evolved to surpass client expectations, drive down costs, raise process efficiency, and increase the accuracy of your data?

Learn more about how to leverage the Nintex Platform in the Financial Services industry by visiting our webpage.

 

Jason Tillman

As a member of the Nintex product marketing team, Jason Tillman focuses on the financial services industry and helping companies automate, orchestrate, and optimize their business processes using Intelligent Process Automation (IPA) technology. He has spent more than 15 years in the technology sector at companies like Microsoft, SAP Concur, and small startups. Jason is based out of the Nintex headquarters in Bellevue, Washington.