Insurance claims management system
The damage team collects the message, documents and partner results, then follows the decision and payment. See which part of the damage has already been resolved and what is still to be expected.
It is not clear in the damage submission what fact is missing for a specific event and who has already requested it. The client receives repeated requests, and the start of the examination is unduly delayed.
How the solution works
- The notice is recorded with the event, the applicant and the information available at that time.
- Protection is checked against the terms of a specific product, significant dates and the contract version.
- The necessary complement, expertise or risk study is assigned to the responsible executor.
- An authorized professional, after evaluating the documents, makes a decision on all or a specific part of the damage.
- Payment or other settlement action is verified, and the customer is told the outcome and which issues remain under review.
Key challenges
- The damage report often lacks the necessary data
- The Damage Solution Fragmented
- Fraud signals not integrated with the damage process
Solution capabilities
Message and Addendum
The time of receipt and facts available are fixed, and additional information required for a particular assessment is requested.
Contractual basis of protection
An appropriate version of the policy, object or insured is assessed and the contract has significant times for the event, claim, and notice.
Partner Task
An expert or repairer shall provide a conclusion and proof of the scope reserved for him only.
Risk Assessment and Decision
The investigation returns the result and authorized effect allowed for the damage resolution; the signal itself is not considered proof of fraud.
History of Judgment and Parts
The reason for the payment, refusal or partial decision shall be indicated. The re-examination shall be linked to the previous decision.
Financial execution verification
The payment order and the order made are recorded separately. Before the case is closed, the beneficiary is checked, the amount paid and the parts of the damage still under consideration.
Business context
- The damage report often lacks the necessary data
- It is not clear in the damage submission what fact is missing for a specific event and who has already requested it. The client receives repeated requests, and the start of the examination is unduly delayed.
- The Damage Solution Fragmented
- The damage case does not link the assessment of the protection, the expert's conclusion, the payment decision and the payment made. The case is closed too soon or it is unclear to the customer which part of the damage is still under consideration.
- Fraud signals not integrated with the damage process
- The risks identified in the damage study do not reach the decision on the specialist making the benefit or it is unclear how it is assessed. The decision on the benefit is made without all significant data being available or the treatment of the damage is suspended without clear justification.
- Damage service determines customer's confidence in insurance
- During the damage, it is important for the customer to know what is missing for evaluation and what action can be expected next. The associated works of partners and the state of payment help to provide a specific answer. Consistent service may be important for renewal of the contract, but its quality is assessed along with a reasonable solution of the damage.
Core features
- Message and Addendum
- Contractual basis of protection
- Partner Task
- Risk Assessment and Decision
- History of Judgment and Parts
- Financial execution verification
Key integrations
- Source of policies and protections
- Historical conditions, the insured or object and significant dates.
- Customer and Partner Channels
- Notice, Target Addition and Proof of Partner Submission.
- Specialized risk studies
- A finding and the basis of the action required are allowed for the decision of damages.
- Finance and Payment Execution
- Authorised recipient, actual payment or its error and correction.
Potential impact (%)
The ranges indicate an illustrative relative change in the metric under the stated assumptions. Results depend on the starting position and actual use of the solution. Percentages for different metrics must not be added together.
Repeated Damage Information Request
12–42%Decreasing
This illustrative scenario assumes that 30-60% of errors can be addressed through the data and rule checks described. That share is assumed to fall by 40-70%. Company data is needed to verify both the addressable share and the resulting change.
Counts avoidable repeated requests for comparable damages.
Time of inspection for the enforcement of the damages decision
16–42%Decreasing
This illustrative scenario assumes that 40-70% of information searches and repeated cross-checks can be addressed. That share is assumed to fall by 40-60%. Company data is needed to verify both the addressable workload and the resulting change.
An active revision of the partner, decision and payment status is measured, separating the necessary research work.
Part of negative feedback on the course of damage administration
4–15%Decreasing
Indicative assumption: 15-30% of negative reviews relate to the uncertain course of damage documents and partner responses. The solution could reduce this proportion by 25-50%. This is a scenario of potential; assumptions need to be verified by feedback collected by the company.
When a company starts collecting reviews, negative feedback about the course of damage administration is calculated from all assessments received on the topic. The same method of assessment applies before and after installation and similar customer groups are compared. Without initial data, the actual change is not determined.
Conditional calculation scenarios. The assumptions have not been validated against client measurements.
When this solution is relevant
- Customer documents, expert findings and partner responses need to be collected from multiple channels.
- The state of damage administration is not tied to the actual execution of the payment, making it difficult for the customer to give an accurate answer.
Implementation requirements
For the administration of damages, the state of receipt of the notice, the terms of the contract and the conclusions of the partners are reconciled. The need for documents is determined by the nature of the damage, and the collection of additional information must retain deadlines and clear responsibility for the decision.
Further development options
- Application of additional types of damage under the terms of their protection and assessment
- Relation of regression or other subsequent processes when executed on a separate accepted basis