For insurance companies, optimization of claims management is a key strategy to reduce costs and increase customer satisfaction in a competitive market. The claims processes for casualty, property, health and accident insurance are not identical. However, we believe that there are some general measures that are key to success:

  • Claims cost can be reduced by introducing vendor and recourse management. Target group strategy and monitoring together with technical innovations can both prevent incidents that lead to claims and reduce moral hazard (e.g. trip recorders in cars, health care technology).
  • A better cooperation between claims, sales and product teams through (1) optimized processes and (2) reward structures can help win low-risk clients, increase client satisfaction and promote cross selling.
  • Multi-channel systems facilitate online claims filing. This is crucial in automating the claims process and brings the industry one step closer towards paperless claims processing.
  • A combination of (1) an intelligent triage of claims and (2) automated checks with a rule engine can strike an optimal balance between operational cost and claims cost. Most insurance companies go for automated clearance of minor cases and an efficient check of claims in the middle cost range. As for large, risky and complex claims, an intensive claims management process is executed by specialized teams.

Implementation of these measures within an operating model requires optimized organizational structures (e.g. teams organized per line of business and complexity of claim) as well as a strategic IT landscape that can be covered by standard software. The final requirement is for highly optimized processes that are clearly communicated and consistently practiced

Our Contribution

  • Re-organization and process management throughout the operations department (claims and customer care) for a non-life insurance company.
  • Design of processes and in-troduction of a process management approach for a health insurance company (sales and claims processes).
  • Introduction of standard claims software for a health insurance company.
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