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Winning on Customer Service – Same Day Claims Payments

By David Nicolai, SVP

My colleague, Maria Parker, and I recently hosted a webinar on the topic of Same Day Claims payments.  It was a focused presentation and demonstration on this specific service offering that insurers should consider as they look to differentiate themselves from their competition today, and to simply keep pace in the very near future as all carriers catch up and begin offering this level of service.  The life and health lines that warrant “Same Day Pay” are Hospital Indemnity, Accidental Injury, and similar products that have exploded onto the market in the past few years since the Affordable Care Act went into effect.

If you look at these lines of business, they fall in the middle between highly automated, hands-off claims and highly manual, hands-on claims.  The former would be represented by traditional health insurance while an example of the latter would be disability or long term care insurance.  With traditional health insurance, insurers and providers work together toward the mutual satisfaction of the insured and handle all of the billing, paperwork, etc. directly with minimal, (if any), insured involvement.  On the other end of the spectrum, products like disability, long term care and others are handled directly between the insured, (the claimant), and the insurer involving numerous paper forms, phone calls, verifications, and other manual processes in order to simply determine eligibility, let alone payout on the claim.

Hospital Indemnity, Critical Illness, Accidental Injury and similar products today typically fall on the manual end of the spectrum, however suitable they are for automation.  These products lack the insurer/provider partnership that exists with traditional healthcare, dental and vision products, but the benefit definitions and transaction frequency are close enough in nature to warrant automation, else they risk completely disenchanting the insured by exposing them to traditional, labor intensive and month-long reimbursement insurance processes.  The beauty is that most insurers have some, if not all, of the tools required to make automation a reality.

The technology tools are simple:

  • claimant online intake
  • streamlined back-end processing rules
  • a push for digital communications and payments.

I won’t go into detail on each in this blog as these are discussed in greater detail during the webinar, which is available for replay here.

However, insurers’ ability to change their processes and their often bureaucratic approaches to servicing, (which are the way they are because of decades old legal interpretations and/or a reluctance to change), is by far the hardest part of making Same Day Pay and overall improved service a reality.  Processes today that entail telephonic notification, followed by mailing of claim forms, followed by completion and mailing back of those forms by an insured, along with copies of applicable invoices is archaic, time consuming and expensive on the part of the insured.  It is equally archaic, time consuming and expensive on the part of the insurer who often times does all this manual work only to have the final result scanned electronically and then entered into the claim system manually until it finally gets to a claim analyst for review.  If life insurers would simply enable the insured to enter all claim forms online and take a picture or a scan of their invoices with their own devices, it would save the insured both time and money and put them in control of the speed at which they are reimbursed.  On the insurer’s end, the claim will be immediately viewable by an analyst, and if the insurer-defined rules are met automatically, the claim could be auto-approved without the need for any analyst intervention.   This saves time and money for the insurer and creates a more responsive overall experience to boot.  Finally, for an insurer to provide Same Day Pay, they need to provide electronic payment versus sending out a paper check.

FINEOS Claims fully supports Same Day Pay and similar modern servicing through the use of the FINEOS Digital Platform that leverages configurable rules and processes married with omni-channel servicing capabilities to deliver service in the manner consumers expect, regardless of the industry.

This blog has only briefly touched on some of our ideas around Same Day Pay. To learn more, register to view this 40 minute webinar on the topic on demand, or feel free to get in touch with me directly at David.Nicolai@FINEOS.com.