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Claims 2012 - Part 3

By Graham Newman, European Product Marketing Manager, FINEOS

This is the third and final part of my blog on the FINEOS Executive Briefing for the London Market at the ACORD offices in The London Underwriting Centre.  My theme was: Meeting the challenges – where is technology going and can it make a difference in 2012 and beyond?

I have covered the catalysts for change and examined the possibilities of enhancement under the topic of Analysis, wherein new technological advances are enabling insurers and claims handlers to derive more value from the burgeoning quantities of data being produced from existing and new forms of technology.  In this segment I shall cover the issue of Access.  I want to explore the way that people’s behaviours are changing in response to new technology and how new forms of collaboration are becoming possible and argue that these new behaviours can be harnessed very successfully in the claims world.

The Claims Ecosystem

I’ll start with a recommendation from Ovum that insurers deploy collaborative capabilities throughout the corporate value chains to speed up business and claims management.  Sounds like good advice to me.  We may ask why this needs to be said at all, does it not seem obvious?  Well, perhaps, but if you are a harassed Claims Director with a high volume of claims to process, not enough claims handlers on your books, with your experienced claims professionals spending too much time on trivial claims and administrative work and all supported by an old claims recording system you may well conclude that you have enough on your plate without introducing radical new work practices without nice, shiny new technology to support you.  Good point.  Fortunately, that shiny new technology is already emerging, and it’s seeing its first successes.  For it to work though it needs us to understand how new technologies have already begun to shape and alter human behaviours and for us to recognise the strengths in new ways of doing things, particularly communicating with each other through the use of collaborative social media.

I have chosen to illustrate this with a look at what we at FINEOS call The Claims Ecosystem, a fancy name not for the claims department but for all the parties involved in processing a claim.  There are a whole range of parties involved in the progress of a successful claim – they are all also involved in the progress of unsuccessful claims too.  But who does the claims system serve?  Well, most of them serve the claims team.  And no-one else, at least not directly.

In the progress of a typical claim there will be the claims handler, possibly a claims supervisor and outside of the insurer there may be any number of others directly involved: the claimant, broker, loss adjuster, salvage experts, engineers, service providers, doctors, nurses, physiotherapists, employers, lawyers, cover holders, etc. etc. depending on the class of business and complexity of the claim.  In a traditional operation pretty much everything has to go through the claims handler, every item of data recorded on the system – and read from it – is done so by the claims handler.

The claims handler soon becomes a bottleneck.  This leads to confusion, complexity, and is potentially a nightmare to manage.  Information latency builds up rapidly in the system and soon leads to many participants suffering from the child-in-the-back-of-the-car-syndrome; “Are we there yet?”.  Place yourself in the shoes of a small business owner with a complex property claim with a side order of business disruption and perhaps a couple of liability sub-cases.  Or perhaps a Risk Manager in a larger corporation constantly under pressure from his board or senior management to provide a running commentary on the progress of their claim.  Their only access to information is likely to be the claims handler and so queries and chasing up status reports may seem to be built in to the claims process to such an extent that it may appear that is its only purpose – to answer questions.  You may not have the metrics to hand but just consider how much time your claims handlers dedicate to simply answering queries and chasing up information for someone else.

So, to the claims handler it appears that they are at the centre of the process, everything and everyone depends upon them and the progress of the claim ultimately hinges on their time and performance, often for aspects of the claims that are not actually their responsibility.  However each involved party feels that they are at the centre of their process, but look at any diagram of a claims system and all its participants and all but the claims handlers are likely to appear at the periphery.  The key to improving everyone’s experience of a claims system, and maximising their time and effort, is to open up the claims system to all parties and let them interact with it as if they are at its centre, at least for the bit of work that they need to do.

How can all this be achieved?  Well, the way in which it is happening now is by the judicious use of what we at FINEOS are calling “Viewpoints”.  You may hear similar devices referred to as “portals”, but the word portal often has other connotations that relate to the wider use of web access and non-work related activities.  Our Viewpoints are the outward manifestations of a different philosophy underlying the configuration of the claims system.  The idea is not just to let outsiders look at what is going on, useful though that may be, but to make it appear to each participant that the system they are using has been designed and implemented for their benefit.  So they are not simply portals into an existing back office system but a true viewpoint of information and processes relevant to each party.

Another way of looking at this is that the claims handler has been removed from the centre of the larger process and been replaced by the claim itself, and each participant has the ability to access just what they need to and is encouraged to contribute their own value to the successful progression of the claim in a way that best suits them.

What we are aiming for here is collaboration and community interaction – between not just departments but everybody.  Each participant has their own viewpoint that puts them at the centre of what they are doing.  These individual viewpoints will make a big impact on claims processing.

The Collaborative Claims Space

Let me take you into a new claims world.  This world is being created now with a FINEOS customer.  We have devised with them a form of viewing and processing claims that owes much to the softer, cuddly world of social media and the cosy and very personal interactive “My Page” type appearance with its multiple posts from different people, its graphical timeline, its photo album and so on.

This social media style may seem like an unlikely bedfellow for the hard-nosed business of managing claims, but consider this:  in 2010 OVUM asked a conference full of insurance executives – business and IT managers – how many had company Facebook or Twitter accounts and they all laughed.  In 2011 they asked them again and more than half raised their hands and no-one sniggered.  This harks back to two of the points I was making at the beginning of Part 1 of this blog on my presentation to the London Market at the FINEOS Executive Briefing, that the ways in which we use technology are changing rapidly and that consumer behaviours are leading the way, with commercial behaviours eventually copying or drawing from them.

Conjure up in your mind’s eye a collaborative work page similar to an interactive social-media style “My Home Page”, actually called in this instance “My Plan” as it is an interactive record of an individual’s recovery progress following a bodily injury claim.  As with a social media page it has personal details on it but this one is all about the claim – or perhaps more precisely it is about all the activities arising from the claim.  It has replaced the traditional claims record and has many different areas.  One shows a series of personal objectives for the claimant:

  1. Return home from hospital
  2. Achieve full independence
  3. Return to part-time work
  4. Return to full-time work.

It has a timeline in graphical form illustrating all the events which have occurred and showing all the scheduled tasks and predicted dates for future events and milestones.

It has a “community” section with small thumbnails of each participant with their name and title, (or role), and a space for posts where each participant can post their latest requests for actions, information, suggestions etc.

If you are not in bodily injury claim processing then don’t let the different line of business fool you.  The global mobile, social media centric world provides a new way of doing things – doing business as well as the trivial stuff like posting your holiday snaps on Facebook.  Any business – including what is done here.

It’s a truism now to say that most individuals have access to much more computing power at home than they do at the office.  Why would people want to have less computing power – an inferior experience – in their office than they do at home?

Society is becoming more virtual and the compelling customer experience translates from home to workplace and brings with it different ways of processing business.

Now visualise this level of collaboration amongst the brokers, agents, lawyers, salvage experts, loss adjusters, medical advisors, client risk managers and client operational managers – and claims handlers in a large, complex, multi-faceted commercial claim.

The potential for this kind of technology – using the newly developed behaviours we are seeing emerging – not just emerging – but becoming the de facto way of doing things – will bring enormous changes to the way in which insurers handle their claims interactions.

Collaboration is the key to greater efficiencies.  Serve everybody’s needs and you will get the greatest efficiencies and the best outcomes.