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Three Ways to Simplify Your Claims Operations

By Barry Duffy, Product Manager

I ran a webinar last week focused on working smarter and improving claims outcomes.  We had a lot of interest which confirms our experience that insurers are thinking seriously about developing new and competitive capabilities in their claims operations.  From what we see, all insurers are looking to improve their claims, but where should you invest to make the most impact?  How can you achieve meaningful improvement in a complex area so critical to customer service?

We see insurers saying that the end objectives are primarily improving customer service and improving financial performance.  There’s a potential dichotomy here as these two areas are often thought of as conflicting, that is improving service costs money so how can you combine that with a better bottom line?

Well, as it happens these two objectives are not contradictory at all, allow me to elaborate.

I characterised the task as simplifying your claims operations and I broke it down into three components:

  1. Streamline claims administration
  2. Work smarter
  3. Improve claims outcomes

Streamline claims administration

What we tend to see is that claims operations have typically created a whole range of supporting technologies, methods, procedures and practices that have evolved over time to manage the demands of claims processing.  These disparate technologies and processes, often referred to as ‘Shadow IT, reflect a lack of integration making for a complex work environment.  By consolidating all these processes within an advanced claims system you get accuracy and efficiency and, importantly you free up your claims handlers’ time to deal with more complex issues.

Work Smarter

Between 75% and 80% of claims work follows what I call ‘the happy path’.  Straightforward, valid claims that you will pay in full.  Processing these claims calls for standard, procedures and automation: low touch or no touch.  The only differentiator here is speed and accuracy.

Modern tools such as real-time dashboards, predictive analytics, SLA driven case management can smooth the operation and identify early those claims that will follow the happy path and those that will require supervision and intervention to resolve exceptions.

Improve claims outcomes

Early intervention by skilled claims handlers can make a massive difference in claimants rebuilding their lives, returning to work and health.  We see operations that use omni-channel communication and portals to facilitate a co-operative effort from claimants, employers and providers, all facilitated through specialist workflows and case management and driven by skilled knowledge workers in the claims team.

Improving claims outcomes benefits everyone

For the claimant:

The sooner a claimant returns to work the more likely they are to recover fully; they get their life back on track.

For the employer:

The employer gets their staff back to work, reducing disruption and easing workload planning.

For the insurer:

Reducing the length of a DI claim can significantly reduce the indemnity spend and free up reserves which should also be more accurate and timely.  A good track record in assisting claimants back to work should improve brand value and may be exploited by the company at renewal of group business.

Improving customer service complements improved financial performance.

To learn more, you can now listen to the Webinar on demand here.

Find out how the FINEOS Claims system can help you achieve these objectives at