CASE - Claim Handling Company

Claim handling

International insurance claim handler makes giant leap in efficiency with Avola Decision

Customer centricity is a top priority in every industry. Also insurance companies realize that consumers and business customers demand swift action, flexibility and transparency. One of our customers in the insurance industry that handles more than 100.000 claims annually, rose to the occasion and implemented Avola Decision for claims handling. This story illustrates how decision management can help improve efficiency, productivity and the customer experience at an international insurance claim handling company.

Challenge: Improving a complex, manual claims handling process
The biggest challenge our customer faced was that claims handling was a complex, inefficient and mostly manual process. Typically insurance claim handlers receive claims on behalf of their insurance clients. To decide whether to reimburse the client and if so, how much restitution they are entitled to, each claim needs to be evaluated personally by a claim handler. As every client has different stipulations and specifications that need to be taken into account, this is a complicated process.

Time consuming task
To make it even more complex, for each insurance customer the claim handling company works with Service Level Agreements (SLA’s). These agreements determine and quantify how the claims of these customers are handled. For example, step 3 in the handling process is not relevant to client A and thus it must be skipped. The SLA of Client B states the maximum throughput time of a claim is 3 weeks, instead of the usual 4. It’s pretty clear that without adequately managing the rules stated in the SLA’s, handling a claim is a very time consuming task.

A second challenge was that too much time was spent on tracking down the right documents. Every claim was administered on paper so tracking down the documents for a specific claim wasn’t easy and resulted in delays in handling the claim. This resulted in productivity issues as claim handlers were spending too much time on either handling a claim or finding a claim in the archive.

Solution: Use decision models to translate SLA’s to business rules
In order to simplify and speed up the claims handling process, our customer chose to implement Avola Decision. This platform helps them map out the logic and rules that are used for making decisions. The SLA’s are a vital element in the claims handling process of our customer and at the same time are the biggest hurdle to ensure speed and efficiency.

Therefore we advised to translate the rules from the Service Level Agreements to rules in decision models. By doing this Avola Decision enables the claim handling company to use the SLA’s to efficiently steer the process. If SLA’s change along the way, the business rules in Avola Decision can be easily adapted without help from the IT department. This way flexibility is ensured as well.

Advantages: Increased efficiency by 30%, improved transparency and  customer experience
By separating the business logic from the process and using the SLA’s to automate the claim handling process, the claim handling company benefits from various advantages.

Claim handlers no longer need to manually go through every step of the process. This has led to more productivity and a decrease of the throughput time. With Avola Decision the insurance company has managed to achieve an efficiency improvement of 30%.

When claims demand human interference or they need to be handled before a specific deadline as stated in the SLA, Avola Decision automatically redirects the claim to the claim handler with the right skill set and prioritizes the claims that need to be handled first. Therefore Avola also ensures the most efficient use of the time and competences of the claim handlers. By integrating OCR technology, the platform can even interpret situation sketches on claim forms to help decide who is responsible for the damage.

Put the customer first
Thanks to Avola Decision, the claim handling company can put their insurance customer first. By saving time in the claims handling process there’s more time to handle complicated cases and to add a human touch. For instance if a customer has had a car accident now there’s more time to talk about how the customer is doing and how they are recovering. This seems like an insignificant detail but it can be vital for the customer experience.

Furthermore, the platform improved transparency in the decision making process. Avola Decision offers easy insight into the business rules that are used to come to a certain conclusion. Instead of a black box the decision making process is fully transparent. Also the platform uncovers the impact of specific business rules. Users can easily test what the implications would be if there were any alterations. This enables our customer to run different scenarios before actually making changes to the system.

In a nutshell

Company:

Insurance Claim Handler

Development time:

16 days

Branche:

Insurance

Activities:

Insurance solutions for traffic, work and home.

Solution(s):

  • Dynamic Case Management
  • Engage

From our client

“Chief Operation Officer at the claim handling company: “I’m impressed how the platform has helped us make a giant leap in efficiency. Avola Decision has structured our decision making process in an incredibly smart way so we can be more flexible, transparent and take even better care of our customers.”
Anonymous
COO, Claim Handling Company

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