An ambulance arrives at the hospital with a patient who is unconscious, has serious injuries, and is in need of immediate attention. The treating physician immediately advises to move the patient into the waiting room and to quickly bring him the patient who has a splinter in his finger. This would not be acceptable in a medical setting but many times in claims this analogy unfolds upon first notice of loss (FNOL). Claims are routed incorrectly only to cause significant delays in handling, reduced customer satisfaction, increased costs, and possibly lost policies.

As frequency and severity continue to rise in claims, the ability to surgically triage claims for fast resolution is more important than ever.  We will examine four key components today that greatly impact the success of triaging in claims:

  • Quality Data: It is imperative to have the right data to triage a claim. Skeleton claims start the claims process clock ticking with little availability to impact the result without additional information. A solution that takes thin data and produces more robust results will allow for more educated decisions in triaging. The ability to develop claimant information from only a name and license plate can be very impactful in claims resolution and customer satisfaction.
  • Severity: Physical damage and injury severity must be correctly forecast to avoid delays in claims handling. The industry has quickly realized that a manual review system is not meeting the needs of staff and customers with an acceptable degree of certainty. Powerful modeling analytics are necessary to identify total claims exposures with a strong degree of certainty.
  • Fraud Identification: Property/casualty insurance fraud amounts to about $32 billion1 a year, according to industry estimates. Fraudulent claims must be quickly identified and routed to the proper claims adjuster for handling. In order to allow for streamlined claims dispatch automation, strong modeling, rules, and scoring are required to separate high probability fraudulent claims from normal claims handling with a low margin of error.
  • Claims Dispatch Automation: Now that you have obtained the right data, identified potential severity, and fraud has been ruled out, automation brings everything together and allows for seamless handling. Fast tracking claims relieves the burden of staffing issues and allows for streamlined handling with improved claims resolutions for customers.

As an industry, claims solutions should be implemented that triage claims correctly with a high level of confidence and little error. As loss ratios continue to deteriorate, the companies that can meet customers’ needs while creating top tier efficiencies will be the most successful in the market.

  1. Insurance Fraud, January 2016, Insurance Information Institute (http://www.iii.org)