Claims as a customer touch point opportunity

We hear on a daily basis that an increasing focus for our insurance clients is to improve their customer relationships through impactful, value add touch points.  The need to increase customer satisfaction and retention has become top of mind and organizations are looking for visibility into how to reach their customers throughout the lifecycle from pre-sales to policy administration through to claims processing. 

As one would anticipate, successful achievement of this objective is dependent upon a combination of two things:  (1) customer focused value added processing, and (2) efficient, integrated systems to support customer visibility.  While striving to support these goals, legacy policy administration systems face obstacles in providing easy access to relevant customer information, and more importantly, prevent rich customer interactions due to functional inefficiencies.  Organizations continue to work towards streamlining operations across their enterprise to provide accuracy and efficiency through integration. 

We’ll focus today on the frequently under-emphasized claims processing function – a functional area that offers significant customer perception opportunities if the supporting platform can hold up its end of the bargain.  As customers’ expectations are increasingly influenced by sophisticated web experiences providing “all in one” touch points, carriers’ focus on customer relationships need to incorporate visibility into policy, billing, and claim information.  Even further, customers should be able to perform key transaction activities, though legacy systems inherently struggle to support these demands. 

The catch is in your systems’ ability to position you for success.  The good news is that a number of current or emerging Policy Administration Systems are available who readily support this customer focused perspective to allow for visibility through the full customer lifecycle, across all polices / products they’re related to.  Some of these systems offer workflow capabilities to complete the new business underwriting process, even allowing for integration into back processing for customer support. 

Claims processing on these systems can inherently follow a similar new business underwriting workflow process, to route and facilitate processing of claims medical reviews, receipt of supporting documentation, aging alerts, and overflow capacity support.  (A residual benefit includes visibility on these claims for subsequent new business to automatically search on client record for pending or processed claims to be considered during the underwriting decisioning process.)   The critical consideration is the increasing importance of efficient claims processing through the policy lifecycle, to achieve both a more streamlined and “standardized” method of claims processing.  The AMA National Health Insurer Report Card noted that a one percent reduction in error rates would drive substantial cost savings to the industry.  Flexible workflow automation for claims processing inherently reduces potential error rates, and allows for support of the “unique” instances that surface in claims processing on a regular basis. 

What does this mean to carriers?  The “bar” has been set higher around the need for efficiency, integration, flexibility, and visibility into their claims process.  Carriers should be working towards all of the following improvements in claims processing:

  • Streamlining operations and gaining efficiencies by reducing manual operations
  • Improving the customer experience
  • Reducing errors
  • Leveraging a flexible workflow to achieve process agility

According to the recent AMA 2010 “National Health Insurer Report Card,” one in five medical claims is processed inaccurately by health insurers.  This is clearly not caused by a lack of effort on the part of carriers, but is a significant outcome of inconsistencies in claims processing.  (The report reemphasizes the need for standardized administrative processes and requirements throughout the industry.) 

At the end of the day, this increasing streamlined and integrated claims processing will be one of the key touch points that carriers can leverage to provide value added services to their customers.  According to a recent Gartner survey, “Gartner estimates that by the end of 2010, 1.2 billion people will carry handsets capable of rich, mobile commerce providing an ideal environment for the convergence of mobility and the Web.”  While the ability to support mobile applications may still be a future consideration for many carriers, we can guarantee that claims information will be one of the key elements that customers will demand to see.

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