Today’s claim operations face more challenges than ever before. Customers demand faster response time and high levels of service. The operating environment is delay-sensitive, with the introduction of new penalties for late payment and levels of self-regulation that previously did not exist. There are needs for high-quality reserving, trend analysis and fraud control. The range of adjusting decisions and processes vary from the straightforward to extremely complex; some areas have multiple-resource, heavy-process demands. Highly trained and available staff is hard to find. In addition, the cost of operations is often a key component relative to overall profitability. General expectations of management include the delivery of high-quality claims adjustment with optimal cost containment.
So how does a claim operation maintain stability and meet the many demands placed on it? One way is to leverage process design fundamentals and support the processes by technology.
Workflows and the skill level of the person completing a function are basic components of cost and effectiveness. The claim operation is fundamentally a production environment with a number of key supporting processes. A process involving complex decision-making requires a higher level of expertise and generally takes longer to complete than straightforward, repetitive or commonly applied process. Segmenting the two becomes a key component to success – especially when availability of highly skilled persons is low, or the cost of employing highly skilled persons is high. Adding technology to the process adds speed and consistency. Of course technology can be expensive, so finding a reliable scalable solution with an appropriate payback period is crucial.
For the Kingsway General Insurance Claim Operation, the solution was an off-the-shelf Microsoft product with customizable features. When coupled with the company’s operating system and custom modules, the software was deployed as an operating desktop that is claims supportive. The product, Microsoft CRM, is customer management software. It has a service module that mirrors basic claims service needs and is customer-centric; also, it has stock capability for managing companies and individual customers.
The initial project documented and reviewed claim processes to establish the fundamental elements required from a desktop. Regardless of claim type, severity or line of business, adjusters have fundamental needs for mechanisms to document activities, to create follow-ups, to track involved parties and to collect and store required information. In the traditional file, claims investigation data such as location, type of vehicle and extent of damage is stored as file “notes.” When the information is required, generally there is a review of the adjuster notes. In addition, the notes tend to house activities such as telephone calls, appointments, task lists and analysis.
Searching for files and file information requires time. It also costs a lot of money because these functions tend to be done by skilled professionals. In addition, commonly-used technology related to the claim (such as email, for example) tends to store in different locations. It is often printed or stored in alternate systems in order to make it part of the file.
The Microsoft CRM product enables data storage, activity tracking, abeyance, email and appointment management. Its service module includes contact and contract management, as well as queuing and triggering.
Working in conjunction with a Microsoft partner, Salentica Systems, Kingsway’s project team added claims data fields and adapted the basic fields and objects to support claims process. Phase 1 began at the end of 2005. During the change, the claim operation made a significant shift in paradigm. We moved from the concept of managing a claim to managing customers who have claims.
The benefits of the new program were immediately evident. Having the information segmented into data fields with ready search capabilities made file review and analysis faster and easier. The resultant decrease in search time allowed adjusters and supervisors to shift to higher value activities.
The introduction of searchable fields provided another benefit as well: customers who had forgotten their claim number could be readily located and serviced. Even customers who had common last names could be readily identified by additional search parameters such as address. Claims with specific criteria became easy to locate for review.
“Notes” were segmented into activity types, providing for clearer tracking of what actions had been taken and when. Activities could be readily viewed, enabling immediate customer response without file search. The segmentation of completed versus incomplete activity provided users with detailed listings of items that required attention.
The program identified adjuster abeyance or file review situations, triggering a message to the adjuster. All activities are managed by means of access through the desktop. Emails and appointments are made within the desktop link to the claim file; they display as completed or outstanding activities with dates attached to them. By having the email functionality attached to the claim, the number of storage steps is reduced; a significant amount of time is saved as a result.
In addition to the CRM product, a module was purchased from Salentica Systems that enabled relationship linking between parties contained in the system. The custom module allows our adjusters to verify the nature of relationships and involvements and to search based on the relationships. The customer and related links being searchable affords us the opportunity to identify not only how we are involved with an individual, but also how often they appear in our system and with whom they have interacted. The functionality allows us to track important clients with custom claim-handling requirements and also to view service providers, customer representatives and individuals involved in any claim record. The relationship types illustrate how the individual or firm is attached to the claim. Moreover, there is significant value in the fact that the setup is customer-centric. Overall, the new module supports a basic business need in our complex venue of claims and it can be leveraged to manage vendor relationships or to detect fraud patterns.
Currently, we are in course of completing the next phase of the development that will allow financial transaction delivery from the desktop. The product currently has additional functionality, such as workflow queuing and alert triggering, that has potential to meet other needs within our organization but that is not yet used. Future actions will take advantage of these additional capabilities to provide underwriting risk alerts and notifications of serious losses.
As with all technology, there is continuous change; with change, opportunities arise. In this case, a readily available off-the-shelf product met the needs for a growing and complex claim pending. For all claim operations, the ongoing challenge will be to capitalize on tools that reduce process cost and support user need. Fortunately, many more options are available. All we need to do is find and deploy the right ones.