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Claims Automation for Exceptional Customer Service!

Dec 12, 2022

The biggest challenge for insurers today is not just digitizing the business but going beyond traditional offerings. Insurance companies are revolutionizing the industry using innovative technologies like AI, RPA, and big data.

For an insurance business, everything comes down to claims. It is one thing that affects clients the most when the insurer delivers on its commitment, and that’s what makes it so essential. With the claim filing process being the most significant factor in customer satisfaction, let’s look at how technology can radically change to costs, operations, and customer experience.

Why automate claims?

Insurance companies often struggle with automation in the first place. Keeping aside the typical reasons like the unwillingness for change or lack of budget & technical resources, there’s one big reason — insurance processes are usually too unstructured to incorporate into the digital workflow. Claims data exists in numerous formats — documents, images & voice memos, and is shared via multiple channels — email, PDFs, chats, etc. ­— making it extremely hard to analyze with high accuracy without an agent’s attention. And when it comes to decision-making, it’s even more complex — understanding the context of each case is required.

Does it mean that the industry can never be automated, and we will require human intervention for every part of the process? Well, not really. But it does require more advanced approaches that mimic human judgment like AI, ML, and robotic process automation (RPA).

Now, let’s understand why claims automation is essential. Suppose a customer files a claim for their damaged car window due to an act of vandalism. Once the claim is filed, there are several steps to follow. Firstly, an adjuster investigates the case to check if it’s covered under the policy. If it is, he evaluates the loss and determines the cost of repairs. The adjuster will then file a report and share it with the insurance company. After which, the company pays the customer. These are time-consuming, manual steps and can take several days or even weeks for an insurance player to settle a claim. This can negatively impact customer retention.

With an automated system in place, you can provide all the necessary information, and then the system will take care of the rest. This might not seem big, but can be a huge time-saver, especially if you have to deal with hundreds or thousands of claims requests on a regular basis.

To explain better, we have created an automation scenario for a simple claims management process:

  1. A customer submits his/her claim using a mobile app/online portal. Chatbots are also becoming prevalent for collecting initial customer details and basic information.
  2. After the data is passed into the system, automatic validation checks review the policy, service provider, claimant, and benefits.
  3. Once the claim passes initial checks, it is further audited by self-learning algorithms and manually by a claims handler, only if required.
  4. The customer is then automatically whether the claim is approved or declined.
  5. If the claim is approved, the payment to the customer is initiated and processed automatically.

This integrated approach to claim automation offers several benefits:

  • Minimum errors through automated handling of initial customer details gathering.
  • Faster claim settlements enabled by automated validation simplify the entire process.
  • Clear communication to avoid confusion.
  • Transparency into claim status while securing customer’s information.

While the claims management process is challenging, insurance companies can leverage the benefits of claims automation to deliver an enhanced customer experience.

Essential Components of Claims Automation
  • Make your core system compatible with other systems.
  • Automate data analysis to speed up and streamline your claims management process.
  • A central repository that connects and combines multiple data sources can reduce manual data entry and errors.
How Can You Automate Your Claims Workflow?
  1. Chatbots can save little money, but significant time and effort. After the chatbot has collected customer’s basic information, it will be provided to the claim handler. This could even reduce the work of a call center agent to an extent under some circumstances.
  2. Early detection of potential fraud can prevent it from becoming a claim. The gathered data is evaluated by an automated system, which investigates claims connections, recurring claims occurrences, social media data, and weather conditions.
  3. Customers need to know the status of their claims. You can boost client satisfaction and loyalty, by offering proactive and automated notifications.
In a Nutshell

Capitalizing on a claims automation solution is worth the investment, especially considering the long-term benefits, such as increased customer satisfaction and reduced operational costs. RPA is an end-to-end automation solution, integrating with all applications and systems — including legacy systems. Moreover, it is entirely scalable and has up to 100% accuracy.

Let’s discuss your project. Connect with us.

sales@kmgus.com

+1 631 777 2424

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420 Jericho Turnpike, Suite 215
Jericho, NY 11753

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Gurgaon 122015, Haryana
Phone  +91 124 4735 555

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