Extending the Claims Ecosystem

Michael Kelly, CEO, FINEOS, for The Protection Review, March 2012

A typical claim has many people and parties in its lifecycle.  There will be the claimant and the insurer, perhaps the broker.  Where health or bodily injury claims are concerned there may well be doctors, nurses, caregivers, vocational rehabilitation experts.  There may be any number of service providers for replacement goods and services.  The whole claims process will operate most efficiently when all these participants can assist to the best of their ability in its successful resolution.  With most claims operations though, the claims handler sits at the centre of a complex web of interactions and communications all facilitated by telephone calls, conventional post and now email and possibly text messages.

This can work quite well; we all know of hard-working claims handlers and well organised claims departments where this burden of communication and flow of information is managed to the best of the claims handler’s ability.  But that, however, is its weakness.  It all hinges on the abilities of the claims handler and the strengths of the claims system which is serving them.  The other parties in the system are neither served nor managed by the process, even though they are required to contribute through the claims handler.  But what if the claims system was serving more than the claims handler?  What if the claims system was extended to directly facilitate the actions of all parties?  Not only that, but what if the claims system was able to manage their contributions, measure their progress and analyse their effectiveness?  The answer to these questions lies in a concept we are turning into reality  here at FINEOS that we term the “Claims Ecosystem”.  This is all about extending the reach, influence, and support your claims system provides in order to derive maximum benefit for all the parties involved in a claim and ultimately the optimum outcome for the claimant.

There are many reasons why the time is ripe for this innovation.  Partly it is due to the expansion of telecommunications and the growth in computing power.  These, of course, are pre-requisites, but the main shift is in people’s attitudes to and expectations from technology. There has been a paradigm shift in people’s experience of internet ‘systems’.  What we think of as the ‘system’ nowadays is invisible to the user.  Leading internet companies such as Amazon and eBay do not see themselves as software companies but simply as service providers.  Couple this with the dramatic rise of social media and its all-pervading influence on consumer behaviour and we see a much greater incidence of involvement in all processes across and through the internet.  This sets people’s expectations of how they should be interacting with service providers.  And the characteristic that is now most prevalent is that of collaboration.  These experiences are collaborative and inclusive; they revolve around community interaction and equal access.

The collaborative model embodied by social media in all its web and mobile incarnations has facilitated great change – in speed, levels of understanding, interactivity, personal responsibility and facilitated massive increase in levels of communication. Overall, accessibility is the stand-out shift in consumers’ expectations.  Access to current information at anytime from anywhere is an expectation that is now the norm as is the ability to interact.   So how can the industry capitalise on this evolution in communication and collaboration?  For us, it is by extending the claims ecosystem from its home firmly embedded in the office of the Claims Department and allowing direct access to all the parties in the claims process.

Much has been made recently of claimant portals, and their introduction to the claims world will certainly increase efficiency and improve customer service.  However, if every participant has their own portal – or viewpoint – into the claims system then each will be able to move the claims process forward at their optimum speed.  In this way each involved party feels that they are at the centre of their process instead of at the periphery of someone else’s.  By increasing the footprint of the claims ecosystem we can open up the claims process to all parties and let them interact with it as if they are at the centre of their process and gain optimum efficiency from everyone.

Clearly each portal has to be tailored to the individual needs of each participant – claimants, brokers, employers, medical advisors, nurses, loss adjustors, lawyers etc. and obviously there has to be a strong, clear security environment to ensure that no-one can see or change any information to which they are not entitled.

The benefits of such a development are manifold.  This will bring faster resolution of claim, but speed is not the only manifestation of a successful claim.  Claimants will no longer have to phone the claims department every time they want to know where a payment is, service providers can submit invoices and track their own payments without having to trespass on the claims handler’s valuable time.  Everyone can be working together to achieve a common, mutually beneficial goal.  Each party can contribute at their optimum speed and capability.  Each will retain a sense of ownership and control.  This answers the question of how to motivate each separate party.  The answer lies in serving both their individual and group needs.

Serve everybody’s needs and you get the greatest efficiencies and the best outcomes.

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