Insuranceciooutlook

The Trajectory of Claim Processing

Pamela Morgan, Insurance CIO Outlook | Thursday, March 10, 2022

Embracing technology and updated software tools to enhance claims processes throughout the insurance and reinsurance industry

FREMONT CA: The pandemic has changed the game for insurers, putting more pressure on them to provide seamless experiences for policy acquisition and maintenance. Claims are at the forefront of this transformation.

Technology must be embraced, and modern software tools integrated into company processes to improve claims processes across the insurance and reinsurance industry and improve customer satisfaction. The significance of putting the customer first when discussing the necessity for a digital-first, future-focused strategy to claims can not be ignored.

Optimal claim processes help insurers to improve the customer experience while safeguarding loss outcomes and lowering costs. The insurance and reinsurance market chains' claims side has long been disregarded. The recent wave of interest in insurtechs has generally concentrated on the sales and distribution element of the market chain. Both insurers and reinsurers stand to benefit from smoothing their clients' claims contacts to provide a more seamless experience and greater satisfaction.

Certain adjustments have been proposed by the insurance regulation to make the claims procedure more customer-friendly and to improve the functioning of Third Party Administrators (TPAs). Insurance companies ought to be more transparent in their claim settlement practices. Claims must be processed in a transparent, smooth, and efficient manner within the timeframes specified. All insurers shall ensure that procedures are in place to enable policyholders to track the status of cashless requests/claims lodged with the insurer/TPA on an ongoing basis through the website/portal/app or any other authorized electronic methods. The status shall extend from the time a request is received until the request is disposed of.

The Insurers should guarantee that the claim's rejection is not based on presumptions and conjecture. If a claim is refused or repudiated, the insurance company must communicate the denial or repudiation by precisely describing the reasons for the rejection or repudiation while referring to the appropriate policy conditions. The insurer must also include the grievance redressal methods accessible through the insurance company and the insurance Ombudsman, as well as the specific addresses of the respective offices. If TPAs are settling claims on behalf of insurance companies, policyholders must be advised of all contacts as well as the location to trace the claims.

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