Getting claims management right

Managing customer expectations

Customer expectations are certainly high when it comes to claims today. Customers want choice in the way that they make a claim, speed in its resolution, and human expertise where it’s called for, explains Hegeler. “They want claims providers to combine technological efficiencies with human skills and empathy.”

This powerful combination is something insurers and claims management companies have been working on. With travel claims often being incredibly complex, the human element will always be necessary, but much of the claims process – for consumers, as well as in the back end for insurers – has been automated, meaning consumers are demanding greater digital interaction with their insurers. “Customers increasingly expect more automation and more self-serve capabilities with their insurance plans, and especially throughout the claims process,” said Butler. “Things like simplification of claims filing, clear and timely claim status updates, quick resolution, and automatic crediting to bank accounts, are common customer expectations today.”

Such automation and a move to digital platforms means that claims can be filed from anywhere in the world, at 
any time. This demand for flexibility and ease of use for the consumer is integral to most financial sectors today, and insurance is no exception. 

“Customers have come to expect the services they purchase to be accessible and easy to use whenever and however they choose to do so,” said Andrew Commins, Managing Director of UK-based Rightpath Claims. “Inevitably, this has led to a drive for a digital-first service strategy and subsequent solution development across a multitude of service sectors, including claims management.” The evolution of any claims process needs to be constantly evaluated, however, and this is something Allianz Partners explains that it does. “We have enhanced our process by reducing required documentation and by adding automation to reduce the overall claim lifecycle,” said Butler. “Our goal is to optimise and simplify all steps and interaction points throughout the process to reduce customer effort and increase success in process completion.” One of the ways this is best achieved, said Commins, is by being transparent and up front with policyholders about exactly what is required of them from the initial notification of a loss. This includes letting them know exactly which documents are needed – or what proof needs to be provided – in order to validate the claim.

Automation drivers

The automation of claims is pivotal to meeting customer expectations around efficiency and speed, then; but which elements are being automated, and what benefits does this bring? As we’ve seen from Allianz’s example, filing claims digitally, being able to look up your claim’s status online, and receiving automated payments, are just some of the enhancements that digitisation has brought. Another company that has invested heavily in such agile technology is Charles Taylor. “Through the integration of automation into our claims process, we have accelerated the claims journey, providing the insured with a stress-free and efficient 24/7 electronic or phone-processing model,” said Hegeler. 

“Payments are made promptly, often in real-time, and our payment choices are extensive; ranging from BACS to Vitesse.” One area where electronic notification of loss (ENOL), in particular, has been beneficial, says Hegeler, is during high-volume claims periods. At times where claims surges have challenged insurance providers to meet customer expectations – such as following the Australian bush fires, Thomas Cook collapse and, of course, the Covid-19 outbreak – enabling claims to be filed digitally has been particularly useful, she said: “By offering customers the option of ENOL for new claim registrations and setting up a fast-track ENOL Lite option for insurer clients not currently using ENOL, we have largely preserved settlement time targets and freed up frontline claims staff to concentrate on the most complex cases during surges.”

In fact, agile technology is also assisting frontline staff. Said Hegeler: “Agile technology should enable frontline claims teams to see a customer’s entire claims and medical assistance profile on a single platform – so that they can ‘join the dots’ of the customer journey and offer the most suitable support.”

Self-service portals, and the technology behind them, have myriad benefits for claimants and insurers. Rightpath provides such a portal, and says it offers not just a streamlined customer experience, allowing users to upload documents and check on the status of their claim, but also, through dynamic question sets and evidence requests, removes otherwise unnecessary claim touchpoints and expedites claims lifecycles.

“By refining, automating, and optimising our processes, we have ensured that what elsewhere might be blanket requests for information, are instead dynamically replaced by requests for only those documents which are required to progress the individual claim, as the claim is entered,” said Commins. “And, critically, we also work to communicate what the claimant can expect in return.” 

Proactive claims versus reactive claims

It’s not just evolving consumer expectations that claims management platforms are aiming to meet. Insurers’ expectations have changed too, says Hegeler, and they are expecting new approaches from their claims management partners. 

“They want claims partners to go beyond ‘reactive’ claims management,” explained Hegeler, “to provide solutions that reduce risk and improve claims outcomes.” Her company’s digital risk management tool, Venture, does this by providing anonymised, aggregated data on the health of mobile employees. The tool, says Hegeler, ‘can help insurers to make intelligent underwriting decisions that have a positive impact on claims’. 
“Specifically, it can identify business travellers at risk of developing a serious illness abroad (including Covid-19) and can correlate risks with the availability of local healthcare,” she said.

Other ways that insurers are proactive about reducing claims costs include working with assistance companies who can refer policyholders to preferred local medical providers, wherever they are in the world, as Michael W. Clark, Area Senior Vice-President and Global Growth Leader at Gallagher’s Multinational Benefits & Human Resources Consulting Practice (Gallagher) in the US points out.

‘Steering’ not only means insureds receive good quality care, but cost control is optimised. Global Excel is a strong exponent of proactive cost control. John Spears, Vice-President of Business Development and Marketing for the Canadian-headquartered company, which offers cost containment, claims management and medical assistance services, told ITIJ: “For a long time, our industry has focused on containing costs after a healthcare event has occurred. This works, but with healthcare inflation rates averaging over eight per cent in the US and the rest of the world, costs continue to rise dramatically. This conventional way of thinking needs to change.”

Thus, the company advocates that intervening much earlier in the process of patient care is the only way to truly manage healthcare risk. “We want to avoid costs first … and contain costs second,” he said. “We accomplish both by directing members to the right type of care before they receive it.”

The challenges of digitisation 

There’s no doubting the advantages that technology has brought to the table when it comes to processing claims. The benefits for insurers, claims handlers and policyholders alike, have been revolutionary. But technology begets technology, and speed begets speed, and, well, the pressure is certainly on when it comes to delivering a speedy and efficient claims service.

“Consumers have always expected companies to offer a relevant and appropriate solution to a need they have,” said Butler at Allianz. “The advantage today is that technology is able to expedite that process to deliver an even more relevant solution, faster. This, of course, means higher demands on technical resources, and increased investment in technology such as robotic process automation.”

The rewards that can be reaped from such investment invariably make it worthwhile – even if there will always be the requirement to continually keep digital systems updated. As Hegeler said: “Whether it’s offering customers digital health services, emergency assistance at the swipe of a screen, or automated claims notifications, claims management providers need to constantly develop their provision.” Alongside the challenges of rapid digitisation has also come the need to keep up with data security and privacy concerns. While this has always been essential for the industry, says Spears at Global Excel, ‘the digitisation of claims has only highlighted the need for increased vigilance due to the high level of automation in the processes’. The insurance industry hasn’t been the quickest to get onboard with digitisation, but it’s made giant strides in the right direction and is seeing return on its investment – especially in the claims arena.

Commins at Rightpath Claims explained what he believes has been holding the industry back: “For many claim management facilities, whether in-house or outsourced, implementing a digital strategy beyond the concept stage represents a significant investment challenge in both time and cost. This challenge is one that must be met for claims management facilities, and, subsequently, the insurers they serve, if they are to deliver on the immediacy customers expect; in turn, retaining a competitive position in claims delivery.” Given the complexity of travel claims, this is no mean feat.

The human touch

A travel insurance claim can be emotive at the best of times for the policyholder – from simple lost luggage claims to cancelled trips, and from flight delays to emergency medical care overseas, all of these scenarios require a degree of empathy due to the stress they cause the claimant. And while many of these scenarios can be compensated for swiftly and via entirely automated processes, at other times, when the claim involves more complex handling, there is no replacement for human case managers.

To this end, insurers and claims management companies have become adept at sorting claims according to the type of handling they will need. Global Excel, for instance, has invested in digital solutions that leverage artificial intelligence (AI) ‘to rapidly analyse needs and direct members with their claims’. “Providing them with options and solutions are key,” said Spears. “Still, human interaction remains crucial: being able to provide pertinent information and advice is highly valued.” The AI processes are used alongside human oversight to ensure that ‘highly trained and specialised teams’ can deal with each sort of claim efficiently and effectively, whether they are fast-tracked, or require in-depth handling. “This ensures that the variety and complexity of the world of claims isn’t lost in a one-size-fits-all mentality,” Spears explained.

Specialist training is essential for claims teams to ensure the right support is given at the right time. “After all, what first appears to be a simple flight delay, could turn out be a very distressing customer experience if it results in a missed family wedding or reunion,” commented Hegeler.

“Claims staff need to be ready for anything.” For her company, such training includes helping frontline claims teams empathise with sick and injured customers by giving them ‘bite-size’ clinical training with the in-house medical team. It’s also important for different teams to work together in order to ensure optimum claims handling, and be able to tap into a variety of specialist knowledge, says Hegeler: “It’s important to have a wide range of in-house specialists to manage the diversity of travel claims. At the very least, these will include doctors and nurses, multilingual assistance teams, experienced claims staff, fraud investigators, international network co-ordinators and cost containment experts; all of whom need to collaborate to achieve effective claims resolutions.”

For full-service assistance companies, having in-house medical knowledge is par for the course today, but for third-party claims companies, this isn’t always considered an option. Those that specialise in travel claims, however, are certainly coming to see this as a must-have part of their service offering.

“As a TPA, adaptation is key,” said Alain Durand, Managing Director for Indonesia and Papua New Guinea for Fullerton Health. “Digitalisation, albeit providing critical tools, cannot, at least for now, replace our multi-disciplinary teams. We opted a few years ago to have doctors involved in all stages of the process, taking the bet that enhanced, medically driven expertise will increase end-users’ satisfaction, and clients’ confidence in our services.” 

The competitive edge

However claims services are offered, whether through an in-house team or via a third-party, remaining competitive is a fundamental part of the business. No longer are online claims submissions and digital access to claims updates, for example, considered out of the ordinary, says Durand. Today, customers want enhanced access to the company handling their claim so they can receive comprehensive and timely updates. 

“Customers prefer to use a chatbox via mobile apps, WhatsApp or some such platform to connect with their TPA,” Durand told ITIJ. “Call centres are becoming full-fledged contact centres, able to manage a wide range of media.” His company has also equipped medical providers with its web-based portal to facilitate claims involving a hospital visit or stay. Not only does this streamline and expediate the claims process, it also minimises errors, he says.

Other companies provide apps as a source for claims information and submission and for communicating with policyholders. Some insurers provide cash or payment cards, removing the need for the insured to pay out of pocket and then submit for reimbursement, explains Dave Richter, Area Senior Vice-President and Global Mobility Growth Leader at Gallagher. Both are ways of simplifying the claims process for customers, meeting their needs, and offer the chance of exceeding their expectations. At the end of the day, when it comes to claims, keeping customers happy is sometimes a tricky path to tread, so digitisation and claims methodology that can bring customer satisfaction is a real bonus, and one that keeps reaping big rewards.

“Customer loyalty and retention are the key benefits to getting claims management right,” said Butler. “The claims process is the pivotal customer touchpoint that can make or break the experience. When handled properly in the eyes of the consumer, not only can you make a lifelong customer, but also that customer is more willing to share their positive experience with others.”