Big Data and Claims analysis:
Advanced Analytics and Claims Validation
If claim is the moment of truth then insurers must primarily focus on improving claims process. Big data maybe hyped but big data if used efficiently can help improve the claims process efficiency.
For example, your customer is hurt at work and this is the 4th claim you have received with similar injury from the same employer in the last 5 months. The same medical provider is doing all the medical treatment and all claimants are being referred to the same chiropractor. Social media information says that the employer is not financially stable. If insurer also discovers that the risk control recommendations were not followed resulting in injuries of the same nature. Analysis of varying nature of data to arrive at each of the above conclusions requires a tool that can bring together large volumes and types of data and analyze very quickly to identify patterns
Claims validation is the process of quickly and efficiently segregating genuine claims from questionable claims. Advanced analytics can prove to be very effective in doing claims validation, as you can no more rely on just traditional claims adjudication process in a very social media rich world today.
For example: An insured reports a stolen car and it happens to be a popular Honda Civic car in a very theft heavy area. Use of indicators would yield a very negative analysis for this claim and would cause more delays. Use of advanced analysis such as text, link, social and machine learning would reveal no anomalies and help you move quickly to resolution and payment of this claim keeping the customer happy about the swift claims process.
Claims Validation and Customer retention
Claims validation is the key to customer retention. Claims validation needs analytics but also human aspect of understanding the insights that the advanced analytics presents and learn from what the machine is learning and form a process that is fair and that works for both insurer and customer. Human aspect is the right skills needed to interview, ask the right questions, and be compassionate during the entire claims process.