How Adaptive Case Management Helped Fix My Car

By Deb Miller (@DebsG360) Mar 7, 2011

In my previous articles, I wrote about the rise of knowledge work and the increasing need for tools that can improve decision making in manual, paper-intensive processes. In this article, I begin sharing some use case examples and invite you to share your examples as well.

My first use case is about achieving better business results using adaptive case management in the insurance claims process.

Faster Settlement is the Goal

Claims processing costs are 3% to 12% of premiums, and insurance companies spend nearly 80% of their income on claims. Because faster claim settlement time is directly correlated to reducing the severity of the claim, efficient processes are a must. Streamlining settlement also helps retain customers, because long cycle times erode customer satisfaction.

If the goal, then, is to drive productivity and improve cycle time in the claims core function, what role does case management play in this scenario?

Organizing Work is the Key

While strides have been made to reduce costs by automating transactional claims processing, cycle time remains a challenge. P&C firms typically have a longer cycle time than other insurance lines. This is driven in large part by the still ever-present “paperwork” burden and the significant element of human judgment involved with managing those claims.

In addition, there is a great deal of third-party data that needs aggregating during this claim management process to collaborate and determine the settlement amount. Because much of this data is paper-based, it is even more difficult for claims specialists to obtain an organized view of the claim. A case management approach addresses these issues, seeking to amplify rather than replace human knowledge and collaboration and thus to improve productivity, cycle time and the business outcome.

So, for example, when I have a “fender-bender” car collision claim, case management can help organize the work:

Lets insurers bring sources of data together for the claims specialist to obtain a single view of the claim for improved assessment
Provides self-service from first notice of loss (FNOL) to status inquiry and information provision
Enables brokers and claimants to track progress of claims
Supports transparent decision making to minimize the risk of fraud or manipulation

And, case management can help insurers balance workload so SLAs can be met and a reasonable foundation for efficient growth can be established.

Case in point — one European insurer case study I reviewed had average auto claim files of 20 pages and, to further complicate the process, more than 10,000 documents a day relating to active claims, such as forms, letters and faxes, arrived in a variety of haphazard ways, from different sources, at different times and at different offices. It used a case management solution to bring all this information together and route it to the right desktop, assigning claims, smoothly channeling incoming information, bundling documents connected to the same claim and prioritizing the work.

The result — case management will help the insurer get my claim settled faster so I can get my car repaired faster.

Customer Satisfaction is the Result

One of my favorite case management success stories specifically focused on customer satisfaction is Pacifica, Crédit Agricole S.A.’s property/casualty insurance subsidiary. With multiple sites and high volumes, claims handling is at the heart of its business differentiation. Quality of service, proximity to policyholders, personalized customer service, innovation, responsiveness and trust, together with a firm grip on underwriting costs, are the key aspects of Pacifica’s claims handling system.