Claims Insights Greater efficiency, better adjusting decision and increased customer satisfaction

 

 

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“Good claims experience builds loyalty.”

Ernst & Young, Voice of the customer: Time for insurers to rethink their relationships

 

For insurers, effective management of claims processing has many business implications - it helps reduce cost, enhance customer experience and loyalty, and sustain long-term profitability.

However, many companies struggle to achieve these objectives. Today’s claims processing involves a great deal of  manual effort - from integrating siloed data to being able to quickly identify new trends and fraud in claims. The results are poor operational efficiency, low customer satisfaction scores, and increased risk for the insurer.

To thrive in today’s highly competitive environment, insurance companies need to take  a different approach to claims processing by leveraging data and advanced analytics. The ability to automate data harvesting and insights delivery to the claims team for better decision-making will define success or  failure of the business. This is the area GoodData Claims Insights solution is designed to address.

 

GoodData Solution

 

GoodData Claims Insights is the leading end-to-end analytics solution purposely built to enhance the entire claims process by automating data integration and rapidly distributing insights to the claims teams.

Accurate and Timely Adjusting Decisions

Orchestrate analytics and data for a 360-degree view of the claims. Reducing claims processing time by up to 60%.

High Customer Satisfaction and Loyalty

A holistic claims view coupled with actionable insights allow claims teams to quickly deliver better service to the customers, resulting in high customer satisfaction and loyalty.

Effective Fraud Detection and Risk Mitigation

Rapidly identify new types of fraud and anomalies by drilling down from the claims dashboards for deeper insights, so claims teams can take proper actions to minimize the risk.

Improved Business Agility

Faster alignment between business operations and changing strategies through integrated machine learning and AI capabilities.

Key features

Manager’s View

Claim and SIU managers gain quick insights on the priorities of the fraud referrals based on the priority scores calculated by a predictive model. Additional information such as the source of the referral, summary of the loss, and who would be the best adjustor for a specific claim is also provided. Armed with more contextual information, claims teams are better equipped to determine the next best action.

Claims Investigation

GoodData provides the ability to pull in all the relevant data from internal and external sources together for claims teams to make informed decisions. This automated process allows the domain experts to spend more time adjusting the claim or fraud referral instead of digging up the relevant information manually.

Producer & Broker Details

Not only does GoodData Claims Insights provide deeper visibility into the policyholder and their claims, but it also reveals information about agent or broker around fraud collusion potential, past fraudulent claims, number of SIU referrals along with loss ratio on their book of business. Such information helps field reps and adjusters make better management decisions for their territory.

Risk Overview

SIU and claims managers can easily obtain a comprehensive view on the risk factors in the claim region. Claims teams can rely on the Fraud Heat Map, as well as additional data points in the target region to make educated claim evaluation and effectively identify potential fraudulent claims

End-to-end Claim Visibility

An end-to-end, time-series claims view uncovers critical information at each phase of the claim investigation while delivering the best next action recommendations powered by machine learning and AI. Claims managers and SIU investigators can hover over the various process steps to view exactly what has happened to the claim and what the next best action should be taken.

Claims Summary Dashboard

Regional managers and claims leaders are provided with a dashboard view with aggregated KPIs vital to their business. A summary of the claims trends by line of business, industry or cause of loss and more is readily available. Key metrics such as Average Number of Days to Close, Reserve Deviation, etc, are also revealed. Unlike a static report, the interactive dashboard allows drill-down into the source systems for further analysis.