Fionna Kossmann Senior Global Claims Manager – Life & Health, Gen Re, Cape Town
The Covid pandemic accelerated investment in technology in the insurance claims space. Unprecedented claims volumes necessitated process changes such as shifting to more digital interactions, adapting the supporting evidence requirements, and adjusting the claims philosophies. Many companies found these changes beneficial and intend to keep them in place. [1]
The successful shift toward more digital product offerings, as well as developments in underwriting and data analytics, has initiated thoughts that operational aspects supporting Claims should follow the same path.
There are already pockets of automation in the claims process emerging, but the absence of end-to-end integration means that a customer travelling through the claims space may still experience a disconnect at various points when it reverts to a manual process.
A podcast by McKinsey[2] discusses the key shifts we’re likely to see in the claims space in the coming years and references the disparate nature of these “single point solutions”. Literature and anecdotal client research by Gen Re reveal the most prominent of these emerging shifts observed across our market.
This blog reviews some of these shifts, many of which are driven by insurtechs, and the implications of claims automation on training the next generation of claims assessors.
Digitalisation Changes
Key digital shifts underway in the claims space where digitalisation is seen include:
Self-service claims submission portals – As more digital products are entering the market, there is an increased need for online submission portals for claimants to be able to interact directly and online with the claim process. Self-service claims submission portals allow claimants to submit documents, file claims, and receive updates on their claim.
Intelligent document processing – There has been a lot of investment in OCR software (optical character recognition). Digital solutions in various markets demonstrate being able to classify documents, data extraction, and data ingestion to populate fields, for example. Digital solutions can also analyse connections between words, which assists with structuring large amounts of data in meaningful ways, thus facilitating efficiency in the assessment process for assessors and reducing claims administration costs.
Machine-driven decisions – Straight through claims processing to claims payment refers to when a trigger, such as a hospital admission or an ICD10 code, is used to make inferences that a claim event has occurred. This approach is especially applicable in markets where products have event-based definitions related to hospitalisation or diagnoses, for example a heart attack for critical illness products. With the aid of machine-driven decisions, in cases like these the claim is then automatically paid out to the insured without requiring any action on their part.
Automated claim assignment – Known as triaging, automated claim assignment assists Claims departments with their inventory management efforts by assigning claims by complexity to the claims assessors based on experience level. Triaging is required to identify which claims are suitable for straight-through processing and which are more complex and should be passed to an experienced assessor.
Claims rules engines – These are said to be one of the main predicted differentiators for a carrier. There are slight variations in what the different rules engines focus on, with some focusing on identifying return-to-work candidates, some measuring degree of occupational disability, and others triaging. Overall, these rules engines promise to enhance resource management, reduce costs of claims administration, and provide transparency and reproducible decision making as well as data analysis.
Claims tools – These provide rule-based guidance to assessors. At Gen Re, we developed the Depression Claims Wizard, which looks at risk factors for mental health conditions and generates recommendations for assessors on how to manage depression claims.
AI Fraud detection – There has been an increased investment in technologies for fraud detection. Some of the primary tools[3] being used are automated red flags, predictive modelling, reporting, case management, and data visualisation.
Data-driven rehab – These are activities supported by the addition of value-added services and insurtech intervention tools that are aimed at shifting the focus to wellness promotion, prevention, monitoring, and management. There are apps focusing on various aspects of health including mental health and pain relief. Some insurers have developed partnerships with providers and apps to offer their insureds a value-added and rehabilitative benefit.
TAKE THE ADMIN OUT OF PREMIUM COLLECTIONS.
- Collect directly into Insurer Bank Accounts
- User friendly collections System
- Dedicated service consultant
- Wide variety of reporting services
An authorised Financial Services Provider – FSP 50552
Moving Toward the Future
As in the underwriting journey space, the end-to-end digitisation of the claims space is inevitable, and the transformation is underway. The mortality space is likely to feel the impact sooner since the assessment process is frequently a one-off assessment making automation of processes easier.
The morbidity space is more challenging, particularly where income benefits are provided. It is here that trained claims professionals are required to assess a higher degree of subjective data and make judgement calls that bring essential human qualities into play – those of judgement and empathy.
Assessors are required to synopsise after considering the interaction of multiple factors such as unique circumstances of claimants and then to make a call on the validity of the claim. Among the diverse factors they evaluate are medical, occupational, financial, and contractual elements.
Analytic techniques and tools are being built to assist assessors’ unique decision-making process.
Skill Sets Required
The inevitable outcome is that claims professionals working in the industry will need to develop skill sets complementary to their traditional professional training:
Skills and Changing Roles For the Future
- The ability to understand, interpret, and analyse information.
- Skilled and experienced assessors playing a critical role in the development of the intellectual property that will come with building automated solutions.
- A possible split in the role or job of the “traditional assessor” with a greater need to focus individuals on specialty skills sets such as data analytics, specialist complex case assessment, and the development, monitoring, and building of tools that will change this environment.
All the above will require broadening of the talent pools and changing the recruitment strategies for Claims team members to meet the demand for the future.
Conclusion
The ever-changing landscape of insurance claims will, over time, need to include more automation. Embracing and incorporating automation allows us to enhance the customer experience, harness our best resources to assess complex claims, and gain efficiencies in processing both simpler and more routine claims. For claims professionals, it opens new and exciting opportunities in different disciplines.
It will be important to develop the talent able to work with increased automation as well as guide future automation for the best outcomes.
This article was originally published on the Gen Re website, by copyright holder, General Reinsurance AG, and is reprinted here with its permission.
Sources
1. The Impact of COVID‑19 on Life & Disability Claims Departments – Results of a Gen Re Survey in the UK Market. By Grace Cairns, October 10, 2022, https://www.genre.com/knowledge/publications/2022/october/rm22-3-en
2. The new standard for insurance claims. By Elixabete Larrea, Michael Muessig, and Samantha Prymaka. May 2, 2022, Podcast: https://www.mckinsey.com/industries/financial-services/our-insights/the-new-standard-for-insurance-claims
3. Coalition against insurance fraud – State of Insurance Fraud Technology Study – 2021 results, https://www.sas.com/content/dam/SAS/documents/marketing-whitepapers-ebooks/third-party-whitepapers/en/coalition-against-insurance-fraud-the-state-of-insurance-fraud-technology-105976.pdf