JUNE - 20238IN MY OPINIONCLAIMS PROCESSING AND MANAGEMENT: OPTIMIZING THE COMPLEX COMMERCIAL INSURANCE PURCHASING By David Mathes, Vice President, Underwriting Systems & Training, Ryan Specialty Groupgovernments are liable to enact swift legislation in response to catastrophic events that compel materially increased levels of labor on claims handlers. Examples of these kinds of increased demands include: compressed resolution/payment timelines, increased reporting requirements to Trends and Challenges in the Claims Processing and Management SpaceIn terms of trends, I see key adjudication methodologies that were more or less ideational years back, now, bearing fruit. Two key areas where I have seen this manifest are in parametric claim payments and the use of AI in fraud detection.Parametric claim payment is one of the more fascinating trends I have recently observed in claims processing and management. Under this workflow, claim payments are automatically triggered in the event of a covered loss. This is an emerging concept in lines such as earthquake and cyber products. It is not an entirely new concept, but we are seeing the concept being realized today far more materially than in the past. The best example of this is the earthquake driven parametric claim process. Should an earthquake occur in a covered territory, the insurer automatically notifies all covered insured that they are aware of the incident and are promptly paying the agreed-upon amount to each insured. Automated payments follow shortly thereafter.Use of AI in fraud detection: More and more companies are now easily able to employ AI software and models to data-mine internal and external data sources to detect certainly questionable and potentially fraudulent claim activity.Continued challenges in the claims management space are the needs of insurers to respond to regularly occurring regulatory changes across different states and countries. Practices that are considered reasonable and acceptable in one jurisdiction may be utterly unacceptable and even considered unfair claims practices in another. Additionally, certain state David Mathes
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