Optimizing Claims in the Face of a Pandemic V2 04-04-2020 (SVIA)

Optimizing Claims in the Face of a Pandemic V2 04-04-2020 (SVIA)

Hello World 2.0!  In a short amount of time suddenly everyone is working remotely.  Indeed, there are a lot of people who work for global corporations and have mastered meetings through Zoom, Skype, etc. and odd hours working with their virtual colleagues and customers.  However, your claims team is probably working remotely right now, and may be struggling to meet deadlines in processing claims. The vast majority of companies are not set up or equipped to suddenly deploy their workforce in a remote environment. How can you maintain control, service customers and be successful in managing a claims team in a remote environment? Communicate, collaborate, cooperate, and leverage artificial intelligence into your claims process right now.

First Things First

The vast majority of insurance companies claims teams are not ready to move in masse into a remote working environment.  Of course, there are people who do work outside of the office, but they are the minority. How do leaders and managers make the sudden shift? How do you ease anxiety and continually connect and collaborate with co-workers, external stakeholders, and valuable customers? How do you implement current and new business best practices? First, let’s get a few things sorted out and in proper working order.

  1. Infrastructure (company laptop or desktop computer, secured VPN, all necessary security safeguards for PII and HIPAA data, conference and meeting platforms).
  2. Prioritize who needs equipment.
  3. Training (in addition to knowledge and skills to use the computer and company software, learn how to use the various conference programs as companies use various products).
  4. Deadlines must be achieved (current State laws and regulations for the business of insurance are still in effect).
  5. Daily team launches (Managers must stay in contact with their teams and provide easy access for questions. Ensure your team member does not become isolated and stop communicating).
  6. Establish best practices for a new way of communication and engagement (establish a way to stay connected formally and informally. What will be missed is the ease of collaboration as there are no water coolers, coffee stations, or lunches for your team to gather with each other).
  7. Identify critical areas where remote work can be highly challenging (e.g. field adjusters, on-site engineers, mentoring juniors) and adopt technology and artificial intelligence solutions to address them.
  8. Recommendations:
    • Create a routine at home that provides for remote work (get-up, get dressed, create a comfortable work space)
    • Flexibility is critical with the family at home. This is one of the best benefits of remote work (no commute, and flexible hours)
    • Managers must trust their teams are working (trust but verify with CMS and other technologies)
    • Ordinarily, productivity does not get affected with remote work on a normal basis. In fact, it will probably go up.
    • Remote work is learned skill, provide coaching and resources on how to do it
    • Be disciplined!

Virtual work is not a new idea.  People in the global corporate world and government sectors have been doing it for a while. What will be missed and immediately noticed is the skill of structuring unstructured time (informal water cooler time or the manager walking the floor and chatting with people).

The Pandemic Impact on Customers and Insurers

Key points to consider:

  1. Survival and impact. Business interruption claims and lawsuits will spike. Traditionally, business interruption coverage is a necessary coverage for business owners (think of natural catastrophic incidents, mandatory evacuations resulting in business closed for a period of time). Small businesses may not survive and will file claims even though pandemics are not covered.  Pressure will be brought to bear by elected representatives attempting to force the insurance industry to honor claims for heretofore specifically excluded perils.
  2. Emergency government actions. Numerous Department of Insurance commissioners and directors have already issued calls for data regarding the business interruption claims. This is common before hearings and subsequent laws and regulations are developed and enacted.
  3. Claims investigation challenges. Claims examiners and outside appraisers and adjusters may not be able to physically inspect locations, vehicles, and damaged property. What are the virtual alternatives to this essential part of claims investigations?  Currently, there is a “Stay Home” order in effect throughout the country. Does your claims team have access to technologies that allow inspections and fact finding from your examiner’s home office? Meanwhile, the clock is still ticking to receive, process, and settle claims.
  4. Customer service.  The end to end customer service experience needs to be digital, starting from claims intake to claims processing to settlement. With high volumes expected, especially business interruption and stress claims, digital processing and use of AI technology to speed up claims processing is critical to manage customer experience.

COVID-19 Insurance Scams on the Rise

The Coalition Against Insurance Fraud[1], and the National Insurance Crime Bureau[2] recently published a list of the different types of insurance fraud schemes utilizing the Covid-19 Pandemic.

Fraud Warning Signs:

  1. Robocalls, plus text and email phishing attacks can pitch false insurance deals to consumers of all ages. These pitches may ask consumers to pay insurance premiums, without delivering coverage.
  2. COVID-19 insurance cons also can work to steal people’s medical and financial identities.

These insurance-related scams are just starting to show up, and early warning is crucial to self-defense. Insurance scams could spread rapidly as scam artists seek new ways to prey on people’s anxiety about health preparedness and social isolation.

Consumers should watch closely insurance-related scams such as:

  1. Scammers are pitching low-cost “coronavirus” or “COVID-19” health coverage. They promise full coverage at affordable prices. Robocalls falsely claim to be legitimate, mainstream insurance companies. People are asked to call a toll-free number; a trained marketer may try to sell coverage. Clicking a link to the so-called insurer may load malware.
  2. Free vaccines, special virus tests or kits. Con artists are pitching free vaccines and tests, claiming they’re covered by health insurance. They’re just attempts to steal the victim’s identity.
  3. Senior scams. Seniors are being targeted by COVID-19 robocalls and other scams that sell Vaccines, tests, “Senior Care Packages” and other frauds are being aggressively pitched. Scammers ask for the seniors’ Medicare numbers, SSNs and other information to make false claims against their Medicare account.
  4. Bogus agents. “Cold-callers” and spam emails claiming to be from insurance agents may pitch false COVID-19 insurance policies. Scammers even have approached residents at senior housing and assisted-living facilities for Medicare ruses.
  5. False insurance cancelation. Callers urgently say a loved one is sick in the hospital with COVID-19. Your health insurance was cancelled, the caller says. You can pay over the phone to reinstate coverage and receive needed treatment.
  6. Bogus travel insurance.Be wary of pitches for travel insurance that claim to cover coronavirus-related trip cancellations. Most standard travel insurance policies don’t cover viral outbreaks or pandemics.
  7. With the surge in the use of virtual calls and meetings, hackers are attempting to take advantage of businesses and consumers.

Remote Claims Submission and Adjustment Technologies

In a remote environment, it is harder for the claims manager to monitor the adjusters’ work. Claims examiners and adjusters may not have quick access to documents and to their managers if they have questions. In such a scenario, artificial intelligence (AI) is a great tool that can help detect patterns and point out things to pay attention to that might get missed. AI can provide various recommendations and alerts that help the adjusters work more effectively in a remote environment. AI can also help predict things such as which claims are likely to go into litigation, so the legal team can focus on them. AI based insights is key in a remote environment.

Artificial Intelligence and Machine Learning Solutions for Claims Processing, Investigation and Litigation

AI solutions will help and yield a great return on investment (ROI) at every stage of the claims process. For example;

  1. Chatbots can help with claims intake and manage the volume of claims.
  2. Fast tracking solutions can help quickly identify which claims can be fast tracked right at First Notice of Loss (FNOL).
  3. Recommendation Engines, such as Infinilytics’ Charlee™[3], can provide recommendations starting from FNOL to ensure compliance and best practices.
  4. AI can detect potential suspicious patterns and alert the adjuster quickly, and enable fast routing of claims.
  5. Litigation prediction, one of the things Charlee is good at, can help prioritize claims for the legal team to focus on; and help identify new patterns leading to litigation and increased costs.
  6. Digitalization of payments with EFT and blockchain technology can help ensure secure and fast payments to the claimant on genuine claims, and manage customer experience.

Now, more than ever, it is very important to ensure your claims process is AI enabled and digitalized.

Building and Presenting a Response Plan

Leaders never waste a crisis.  Now is the time to be bold and take steps to gain control of your new working environment. The Rule of Three doctrine for problem solving and strategic planning can assist you in getting things started.

Problem Solving

  1. Cooperate
  2. Communicate
  3. Collaborate

Strategic Planning:

  1. State the Problem.
  2. Define the Possibilities.
  3. Execute

Please contact us at: info@infinilytics.com, or (844) 826-6906.

 

[1]http://www.insurancefraud.org, [2]https://www.nicb.org, [3] www.infinilytics.com

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