How structuring claims data collection can lead to improved claims experience

Policyholder experience is heavily impacted by the amount of unstructured data and communication that flows between carrier agents, claim adjusters, and policyholders. FNOL (First Notice Of Loss) is especially prone to a lack of structure which can lead to delays in claim processing and bad customer outcomes.

Claims experience is incredibly important for profitability in the insurance industry. A positive claim experience can encourage policyholders to renew their policies and even help to acquire new customers through word of mouth. On the other hand, a negative claim experience can lead to policyholders canceling their coverage and leaving the insurance company in favor of competitors at a financial loss.

Dissatisfaction around the claims experience is a key reason driving customers to switch insurers. Accenture estimates that $170 billion in insurance premiums could be at risk within the next five years. In addition, process inefficiencies in underwriting could cost the industry an additional $160 billion over the same period.

Benefits of a structured claim data collection process

One of the major impediments to claim processing is unstructured data and communication. Data is collected via emails, phone calls, and other dispersed forms of communication, which can be difficult to manage.

In addition, there are multiple parties involved in claim processing - policyholders, claim adjusters, and carriers. For example, with FNOL (First Notification Of Loss), the claim adjuster may need to contact multiple parties for exact information on what happened.

By taking the time to create a structured data collection process, insurers could more efficiently collect data from all parties quickly and accurately. This would allow claim adjusters to easily track all claim-related information in one place and quickly access the required claim documents for fast claim processing. This helps reduce claim cycle time and reduces customer frustration over delays in claim settlement.

In addition, structured data collection can help insurers reduce claim fraud. With today’s unstructured claim process, it is difficult for an insurer to determine if all of the information provided is accurate or not. By having a structured claim collection process, insurers can easily detect any discrepancies or inconsistencies in the claim data.

To ensure policyholders have an efficient claim experience, it is essential to establish a structured claim submission process. By implementing the right processes, carriers can create an efficient claim flow that ensures claim data is collected, verified, and processed quickly. Structured claim submission processes have the following key benefits:

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1) Improved accuracy of submitted data as all relevant details are collected in a standard way;

2) Reduction in overall claim processing times;

3) Streamlined claim resolution process;

4) Improved claim fraud detection; and

5) Enhanced policyholder experience.

Structured claim data collection also helps to reduce misunderstandings between policyholders and carriers, leading to a better claim experience for all involved and improved customer trust.

Typical claim data collection flow

There are multiple steps and parties involved in claim data collection. The typical claim data collection process involves the following steps:

1. First Notice of Loss (FNOL)

The most common way to report a claim is via the call center. The carrier or the agent will collect all necessary claim-related information and document it in a structured manner to ensure accuracy and quick processing.

The claim can also be submitted via self-service channels such as a website, a chatbot, or a mobile app.

No matter the channel, the FNOL process is an important step to ensure claim information is collected in an organized and structured way.

The process involves:

• Gathering basic claim details, such as policyholder name, claim incident date and location, claim type, and claim severity
• Documenting all claim information and data entry into claim systems.
• Sending the policyholder a confirmation email with claim details and case number

2. Gathering claim documents

Once FNOL is done, claim adjusters work to collect all relevant claim documents, such as accident reports, pictures of the damaged property, and receipts for repairs. At this stage, claim adjusters may need to inspect claim-related property or assets to determine claim eligibility and the amount of coverage.

This process often includes back-and-forth communications with policyholders and other stakeholders to:

• Request additional claim information if needed
• Discuss policy coverage and claim eligibility with the policyholder
• Explain claim processing timeline and other relevant claim details.

3. Claim review and verification

After all the data is collected, claim adjusters will verify the claim information to determine claim eligibility and the amount of coverage.

Claim handlers often have to follow up with policyholders multiple times via email or phone to confirm claim details and document any additional information needed to process the claim.

4. Claim processing

Once all the claim data is collected and verified, claim handlers can process the claim according to policy terms. This includes assigning claim values, approving claim payments, and tracking claim progress.

5. Claim Payout

Once claim processing is complete, claim handlers will issue payments or repair estimates to the policyholder.

The importance of a structured claim data collection process

The claim process is often complex and involves multiple claim adjusters, policyholders, agents, brokers, and other stakeholders. Having a structured claim data collection process helps to ensure claim information is collected accurately and efficiently while providing the best customer experience.

Unstructured claim processes between agents, carriers, claim adjusters, and policyholders can lead to delays in claim settlements, a lack of visibility into claim status, and, ultimately, a poor claim experience.

Implementing a structured claim data collection process can help to avoid these problems. Establishing an organized FNOL process is the first step to creating an efficient claim flow and improving customer experience, but it is important to structure claims communications throughout the claims lifecycle as well.

This will enable claim adjusters to quickly collect claim data from policyholders, reduce claim cycle time and improve claim settlement outcomes. Ultimately, this will result in a better claim experience for policyholders and improved customer satisfaction for carriers.

The bottom line:

Creating an efficient claim flow requires structured communication between claim adjusters, agents, policyholders, and other stakeholders. By structuring claim data collection processes, carriers can ensure claim information is collected accurately and quickly, reducing claim cycle time and improving claim settlement outcomes.