Improve your customer service by improving your claims process

Original article appeared in CoverTechFest 2023 (page 81-82).

All insurers are continuously looking to improve customer service and financial performance. A more efficient claims process can materially help both these goals.  

The question is what is the best way to do this? A key initial step is to fully commit to doing so. An additional important step is to identify how you would ideally like your claims process and claims outcomes to work. Thereafter, you need to identify the redesigned processes, enabling technologies and implementation steps to move you from your current state to your defined desired state. 

Technology holds some of the power. Speaking on a panel at Cover Magazine TechFest 2023, Paul Donnelly, FINEOS executive vice president, EMEA, noted that one sure way to improve customer service is to automate processes.  

Progressive global insurers have been using workflows and integrations between their various systems to speed up and improve service in managing claims. They use customer portals to improve personalisation and enhance the customer experience. Claims that satisfy predetermined criteria can be auto-adjudicated and paid out to the claimant much more quickly than with manual approaches. Artificial Intelligence (AI) predicts how to best handle a claim based on historical claims experience, and how best to communicate with the claimant. The required actions can then be automated, resulting in quicker customer service and efficiencies.  

A recent PwC African Insurance Survey identified that insurance executives believe that technological change is the No. 1 global trend that will affect the local insurance industry. The executives indicated that they must progressively decommission legacy systems and achieve greater system integration, and that the benefits of introducing automation include cost savings, improved control, enhanced quality, scalability, and real-time servicing.  

A 2022 Deloitte survey of 500 senior cloud decision makers in the US  found that, “organisations are increasingly using cloud investments to boost business performance.”  

Modern claims processing software providers like FINEOS can enable your digital transformation by putting the customer at the centre of the system design. Seamless integration of people, processes, and technology deliver streamlined operations that provide optimum customer service. Enabling technologies such as imaging, easily configurable workflow, rules engines and cloud underpin the solution. Analytics and AI capabilities add additional value by, for example, helping to identify which claims can be paid automatically or which claims have the highest propensity for fraud. Most importantly, unlike legacy systems, modern claims software is never out of date. Instead, systems like FINEOS Claims have their core software updated frequently with little or no interruption to the insurer. The system never becomes legacy.  

John Murphy, FINEOS Business Development Manager South Africa, is based in Johannesburg, and will gladly engage with you about how FINEOS can assist your organization. 

FINEOS is a leading provider of core systems for life, accident and health insurers globally with 7 of the 10 largest employee benefits insurers in the U.S. as well as a 70% market share of group insurance in Australia. With employees and offices throughout the world, FINEOS continues to work with innovative, progressive insurers in North America, EMEA, and Asia Pacific. 

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