Maintaining the Human Touch when Transforming Insurance Claims

As insurers turn more claims over to enabling technologies like artificial intelligence, businesses should expand the responsibilities of claims.

FREMONT, CA: Professionals must use cutting-edge solutions while preserving a personal touch during critical moments. Customers do pay close attention to how an insurer handles claims. The component might be essential to client retention and growth because a claim might be the only consumer interaction with an insurer. Adjusters, managers, fraud investigators, and other claims professionals should be progressively supplemented and augmented by advanced technologies and new data sources. These advancements should free them up from several time-consuming but low-value chores and provide them with the resources they need to expedite case settlement and payment.

Managing the customers

Claims specialists must be able to manage both more complicated claims and less complicated instances that call for individualized care. It entails receiving instruction on how to deliver convincing stories that could clear up misunderstandings and prevent conflicts from being resolved by using external parties like courts or arbitrators. Adjusters and managers won't always handle claims from beginning to end as more persons with digital solutions are encountered along the road, but who are popped out by the automated process due to an anomaly or other issue outside the system's guidelines, necessitating human intervention. Therefore, many respondents proposed developing claims models that identify when a consumer is having a problem while allowing actual adjusters or managers to intervene and offer the necessary support.

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Technology expertise

Members of a claims team should be heavily involved in developing and testing automated systems to ensure they perform correctly and provide mechanisms for human intervention when necessary, in addition to being familiar with the nuances of insurance policy language and trends in disputes over terms and conditions. For instance, a broken or poorly constructed algorithm could lead to widespread underpayments (likely prompt pushback from clients and authorities) or overpayments and case reopening (which could leave insurers with a serious claims leakage problem).

Data analytics

Departments handling exponential claims should include team members skilled at drawing conclusions put into practice from all the alternative data and cutting-edge technologies and those closely involved in developing the quantitative data models that underpin straight-through processing. If claims are their departments can effectively use such real-time information, data collected by sensors (whether from cars or in insured properties, for example) may be the most significant game-changer.

Business acumen

Claims departments automate more tasks and cases, and skill sets will change to focus on problem-solving and critical thinking at the departmental and corporate levels. Currently, managers are in charge of an entire ecosystem for vehicle insurance. Instead of being task-oriented, it is more outcome-oriented. For instance, new technology may make it easier to overcome tunnel vision, which is managing files one at a time rather than evaluating claims portfolios across lines and geographies.