Categories: Business

Rethinking the Importance of Insurance Claims Management

An insurance claim offers the provider an opportunity to hold up their end of the bargain and come through for the policyholder in their hour of need.

Historically, the industry as a whole only saw claims as a contractual responsibility, instead of as an opportunity for building loyalty, enhancing the customer experience, and improving retention rates.

In today’s saturated insurance industry, insurers that provide a seamless claims process are enjoying an edge over competitors.

Understanding Insurance Claims Management

Here’s a short overview of all the steps in an effective insurance claims management process:

  • Obtaining the policyholder’s notice of claim.
  • Establishing to what extent the loss is covered by the policy.
  • Collecting all the necessary documents.
  • Ensuring that the claim is not fraudulent.
  • Making repairs.
  • Compensating the insured.

Once all the information has been gathered, the claims manager can swiftly process the claim and reach the correct conclusion.

The Expectations of Policyholders

Unsurprisingly, policyholders expect a quick response from their carriers once they’ve notified them of their loss.  

In cases where a significant loss has occurred, carriers need to ensure that a subject matter expert reaches out to the claimant to discuss the process. It’s essential to promptly reassure the claimant about the scope of their insurance policy.

Expedite Claims Management

The insurance claims process begins when the policyholder files a claim. The next steps determine whether the claim is valid.

Since speedy claims resolutions mean increased customer satisfaction levels, a seamless claims process is a key differentiator moving forward.

Human Oversight is Necessary

Human adjusters will continue to play an important role in the claims management process. And with business rules engines, insurance carriers can work more effectively while still maintaining close human connections with their policyholders. 

A business rules engine helps carriers to approve confirm simple claims with common features and outcomes. As a result, the claims team can focus their attention on more complicated claims. 

Proactive Instead of Reactive

Insurance companies need to be proactive and anticipate the needs of their policyholders. 

For instance, an insurance provider’s business rules engine could alert the insurer that a policyholder has not yet finished a set of treatments.

Preventing Fraudulent Claims

Insurance is one of the sectors that’s suffers the most from fraud.

Clearly, indemnifying fraudulent claims eats into the profits of insurers who then in turn pass the expenses on to policyholders. Basically, the more fraud there is, the higher the premiums become.

Fraud Detection with Business Rules Engines

A business rules engine can act as an effective fraud prevention solution that can identify fraud in real-time. 

Insurers deploy business rules to examine transaction history and spot trends in claim payoffs. This is critically important when insurance companies want to identify fraudulent claims.

For example, if an insured file claims on a frequent basis, then this could be a red flag that warrants further investigation. 

Conclusion: Claims Management with Business Rules Engines

Insurers can smoothly oversee the entire claims process with a rules engine — from notice to reimbursement. They can optimize the claims management process and properly evaluate claims.

Business rules engines automate repetitive and time-consuming processes, which enables the insurance company to build a closer relationship with the claimant during the difficult time.

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