Your most valuable asset is trust

State of California, Department of Industrial Relations, Division of Workers’ Compensation, 24th Annual Education Conference.

Dates: February 23-24, 2017, Los Angeles, California and March 2-3, 2017, Oakland, California

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A claim is the moment of truth for an Insurer, with a balancing act between Customer Retention versus Claims Handling on one side and Claims Expenses versus Premium Increase on the other.

Customer Retention is directly related to claims handling experience especially within the Insurance business. With a varied amount of Insurance choices available these days, your customer needs to  trust you at times of need. Insurers need to balance customer trust with claims due diligence and payments. During this assessment, if customers’ experience goes sour, the insured feels that their trust has been compromised and subsequently, they would leave. No amount of marketing can replace a better claims experience. Because claims is also the time when compassion is needed as customers go through a tough time as it is, so if their claims experience can be quick, efficient and effective, you have retained a customer for life.

FACT: U.S. Casualty and Property Insurers waste $30 billion annually on fraud, affecting profit margins and increasing staffing hours.

Claims expenses on the other hand is an inevitable expense to examine the claims thoroughly to make sure there are no material misrepresentations and you are not paying a claim that you should not be paying. At the same time if you take too much time to process a claim, there are legal consequences, which might add to the claim expenses.

FACT: Too many legacy applications, varied and large amounts of data, manual and laborious tasks of gather and analyzing data. Big data is everywhere but applicability is minimal due to lack of resources and clear possibilities of many big data technologies and its integration with legacy data sources.

A well-known axiom in risk management is: “If it is predictable, it is preventable.”At Infinilytics we believe that advanced analytics when combined with management buy-in is in built into the claims process from the start along with an intelligent tool that handles the manual and repetitive tasks would help alleviate the claims inefficiencies and pay out delays.

Behavioral Patterns are truly more effective than data field indicators in identifying anomalies, which if filtered out quickly in claims process can help fast track genuine claims. There is no reason to hold on to a claim if it shows no pattern of anomalous behavior if you have a tool that can continue to monitor for any developing patterns.

Comprehensive analysis of claims data needs internal claims data and external data to be merged together and then analyzed for any patterns. Analysis should be done each time new data is added to that claim. Big data and advanced analytics truly is a medium by which insurers can achieve this balance and stay competitive in this marketplace.

Automated Data Gathering

The claims representative is the critical link in your business process.  Accurate information must be obtained from the policy holder, claimants, and other individuals involved in the claim. The claim representative must be able to accurately analyze all of the facts, and determine if the stories match the evidence of the claim. If you automate the data gathering process and collect the right external data, and then leverage it with your internal data. patterns and trends quickly appear, which leads to better decision making by your claims team.  You can increase your team’s accuracy and efficiency, and lower the costs to process claims.

Fast Tracking Payments

Genuine claims need to be validated quickly to avoid unnecessary delays, and in certain cases, expedite fast track payments.  Insurers can’t pay claims quickly enough.  The insurance promise is brought into question during a delay in claim payments

Customer Retention

Insurers realize it is far cheaper to retain a customer than to recruit one.  In their attempts to retain customers, they frequently extend multiple discount policy offerings or other incentives.
Since paying claims is directly related to customer retention, if a genuine claim is delayed, the customer becomes disgruntled and may move their business elsewhere.

For most insurers, complex business regulations frequently dictate the timelines for processing claims. If adjustors are rushed, it can lead to wrong decisions.

At Infinilytics, we believe that best practices for insurance claims analytics come down to the four R’s.  

Having the Right Data, at the Right Time, to the Right Person, for the Right Decision.