Time to redefine, not speed up the ‘flawed’ claims process

Time to redefine, not speed up the ‘flawed’ claims process | Insurance Business

Time to redefine, not speed up the ‘flawed’ claims process

Claims adjusters in the US are under enormous amounts of pressure. The strain is coming from multiple issues, including the prevalence of outdated claims management systems, the shortage of experience and capacity, and the intensity of customer expectations in today’s on-demand economy.

For some time, there has been a problem with the triage and effective routing and distribution of claims. Adjusters complain of being assigned here, there, and everywhere regardless of their geographic base, technical expertise and access to resources.

However, the claims sector is being redefined with the help of new technology like Claimatic, a cloud-hosted claims management platform designed to streamline and dynamically automate insurance claims intake, triage, evaluation and assignment.

“Claimatic is a plug-in software as a service (SaaS) solution for intelligently monitoring the processing and assignment of insurance claims,” said Claimatic CEO Larry Cochran. “It acts like a bolt-on brain that plugs into and augments existing legacy insurance systems. It does this by pulling dynamic data to constantly monitor real-time statuses of claims management resources.

“When a claim is filed with an insurer, Claimatic triages the claim and then determines and assigns the optimal resources needed to deal with the claim. The whole process takes seconds and provides a much higher probable success outcome for the claimant due to the speed and improved resource matchmaking that Claimatic provides.”

A common pain point for claims adjusters revolves around arbitrary geographic case assignment. While most insurers have made some efforts to automate their claims management processes, not all are using truly efficient systems, according to Cochran. Many automated systems use an aligned round-robin process that assigns claims on a rotational basis, but not necessarily in the most efficient manner. It “speeds up an already flawed process,” Cochran said.  

“From a customer standpoint, every geographic area can have its own culture and its own idiosyncrasies in terms of construction. It can have a really big impact if you keep assigning an adjuster to a tight cluster area because that adjuster will be able to develop a strong understanding of the culture and construction of the neighborhood. That will help them gain more credibility as a local loss adjuster,” Cochran told Insurance Business. “Typically, adjusters don’t have that luxury. They’re being asked to move around all the time and forced to re-learn through every claim they’re dealing with.”

Optimal claims management technology can also help to identify red flags for fraudulent claims, Cochran explained. Firms simply using a round robin process of automation without using dynamic data to identify fraud, are at risk of speeding up and making is easier to pay out a fraudulent claim.