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.
Here’s a short overview of all the steps in an effective insurance claims management process:
Once all the information has been gathered, the claims manager can swiftly process the claim and reach the correct conclusion.
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.
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 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.
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.
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.
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.
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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