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Do your insurance claims systems support these three business imperatives?

Do your insurance claims systems support these three business imperatives?



Claims management is a priority issue for property and casualty (P&C) insurers. Many P&C insurers, however, operate with claims systems that are less than optimal. Key functions often prove inadequate ...

Claims management is a priority issue for property and casualty (P&C) insurers. Many P&C insurers, however, operate with claims systems that are less than optimal. Key functions often prove inadequate in facilitating faster loss reporting, improving adjuster efficiency, increasing customer satisfaction, quickly adapting to market changes and providing actionable management information.

In quantitative survey research with C-level claims executives conducted in mid-2012, Accenture found that most insurers agree on the lack of modernity and flexibility of their claims management systems, especially in terms of allowing change in system behaviors and business processes and in addressing consumers’ evolving needs. American P&C insurers plan to invest an average of $17.5 million in their claims functions over the next three years, and more than one in five plans to invest more than $20 million.

Ultimately, claims systems should be able to support three key business imperatives.



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    Do your insurance claims systems support these three business imperatives? Do your insurance claims systems support these three business imperatives? Document Transcript

    • Choosing the RightPath to ImprovingClaims Systems
    • Claims management is a priority issue forproperty and casualty (P&C) insurers.Filing for a claim, in fact, is the “moment of truth” for an insurance customer– the time when the insurer demonstrates its ability to process informationquickly and efficiently, analyze the situation and act upon the facts provided.Many P&C insurers, however, operate with claims systems that are less thanoptimal. Key functions often prove inadequate in facilitating faster loss reporting,improving adjuster efficiency, increasing customer satisfaction, quickly adaptingto market changes, and providing actionable management information.In quantitative survey research with C-level claims executives conducted in mid-2012,Accenture found that most insurers agree on the lack of modernity and flexibility of theirclaims management systems, especially in terms of allowing change in system behaviorsand business processes and in addressing consumers’ evolving needs. As seen in Figure 1,U.S. P&C insurers plan to invest an average of $17.5 million in their claims functions overthe next three years, and more than one in five plans to invest more than $20 million.Accenture is a pioneer of advanced claims capabilities – built on more than a decade ofexperience working closely with the industry’s most recognized and respected insurers.Accenture Claim Components, a comprehensive approach to claims modernizationand optimization, is designed to support insurers’ business imperatives and providemaximum flexibility, agility and efficiency. Insurers can choose the components andan implementation approach designed to reduce disruption and minimize the resourcesneeded for implementation.Claims are emotional events and good service is important for customer retention,customer growth and for potential referrals. Consumers want the ability to report aclaim and then track the progress of their claims using the channels they prefer. Somepeople prefer to talk to a claims professional to report a loss; others prefer to checkon the status of a claim using a smartphone, or to communicate using online tools.To meet customer needs, insurers must be positioned to service each customer in themanner – and according to the need—that they want to be served. The days of one sizefits all are behind us.Therefore, modern, flexible claims systems need to be nimble enough to support onlinecustomer self-service as well as provide access using a mobile device. Accenture ClaimComponents provides support for call center loss reporting, service portals for agentsand consumers who want to handle questions themselves, and a powerful claimsmanagement solution for adjusters, all buttressed by a single point of configurationand maintenance.Figure 1: How much does your organization plan to invest in its claims functionover the next 3 years?Over $25 million 26%Between $25-10 million 10%Between $10-5 million 10% Average: $17.5 millionBetween $5-1 million 24%Between $1 million & $500,000 6%Below $500,000 12%No investments planned 12%Source: Accenture North American Claims Investment Survey, 20121
    • 2
    • Driving the Businessthrough Claims3
    • Ultimately, claims systems should be able to supportthree key business imperatives:1. Respond to changes in systems such as Accenture Claim Accenture’s approach is to enable Components can integrate them into configuration by non-developers,business process. an automated workflow. who manage the behavior of ClaimSophisticated insurers move rapidly Components using the software’sto adjust to market conditions and to Accenture Claim Components comes configuration tools. These are user-bring new products and services to complete with many preconfigured friendly and allow a trained andconsumers. A large national carrier, interfaces and adapters to speed up claims-savvy user to add fields,for example, transformed its claims the integration process, while also make edits, alter assignment rules,management system to be able to lowering implementation costs and shift assignments to various users,respond to catastrophic events while maintenance costs. These are standard, create and define task generation,experiencing little disruption to normal reusable interfaces that align with and perform similar activities withoutoperations. Other insurers have invested business needs – such as an interface IT intervention, except for the mostin configuration consoles that enable to appraisal networks. Other integration complex needs. The configurationthem to set up their claims system points can be used for common tools are self-documenting, segregatequickly for new product opportunities, claims settlement needs, such as configuration from base code toletting the business owners define address verification, OFAC, Medicare ease upgrades to newer releases,system processing requirements. reporting and downstream reporting. and manage the promotion of new changes through test environmentsBusiness process investments are not 3. Allow changes in system to production. Claim Componentsrestricted to technology purchases. configuration tools allow carriersChanges in workflow can help claims behavior and business to use resources that do not requireprofessionals concentrate on rich value- processes without IT IT specialization for routine systemadded activities and allow for rapid intervention. administration, so that the IT team canresponse when there are shifts in the focus on more strategic IT projects.business. Accenture Claim Components Accenture’s North American Claimsenables claims teams to quickly react to Investment Survey demonstrated thatevolving business conditions. most insurers feel their claims systems lack the modernity and flexibility to2. Integrate with other allow changes in systems behavior and business processes, and to address theinternal and external evolving needs of consumers.systems. For example, 40 percent of respondentsClaims systems previously had to handle answered “not at all” when asked if theironly internal, structured data related claims management system was modernto policy verification and coverage and flexible enough to allow changeconfirmation. Now such capability in systems behavior and businessis taken for granted and systems are processes without intervention fromconfigured to deal with a host of the IT department. Another 43 percentthird party service offerings. New said their system was able to do sosystems should, for example, integrate only to some extent. Only 17 percentautomatically with predetermined of respondents said their systems canvendors based on business rules. These allow such change “to a great extent”.might include rental companies for At present, it takes too long to design,customers who require transportation code, and retro-fit process-relatedwhile their vehicle is being repaired, workflows into older systems. As afield adjusters’ or appraisers’ result, these tasks are handled as aassignments, body shops for vehicle special manual process, or dealt withrepairs, and many others. Many of these using a third party solution that wrapsprocesses are performed manually around the core application.by adjusters today, but sophisticated 4
    • Top Priorities forFuture investment5
    • In response to our survey, P&C insurers identified threetop priorities for future investment in claims systems.While investment in each area can deliver significantbenefits, there are also significant challenges toimplementation that must be addressed.Priority 1: combinations and can review your useful in helping junior adjusters gain experience with similar claims for clues the process skills of a senior handler.Core Replacement that might raise a red flag. Accenture Claim Components offers aToo often, companies want to well-designed and intuitive interfacereplace their core system but the IT Claims analytics is also being used that can be easily learned by claimsdepartment is backlogged or not in a in new areas, with the potential for professionals of any skill or background.position to take on another project. significant impact on outcomes. ForAccenture offers Claim Components example, analytics can identify which New claims recruits leave collegein a Software as a Service (SaaS) claims are likely to involve litigation, using smartphones and tablets as theirimplementation model as a way flagging them earlier in the claim primary tools for communication andto have your claims department handling process so that a specialist can expect their employer to provide thetake advantage of the capabilities be assigned to help avoid litigation in same type of technology that they useof Claim Components without the the first place. Better initial handling or daily to interact with their bank, creditneed to implement and maintain the different positioning for a settlement card provider or online brokerage.system in house. Accenture will host may head off a legal action and reduce litigation expenses. Most have no desire to begin aClaim Components, perform system career where they sit in front of amaintenance, upgrade to new releases, Subrogation is another area where 1970s-era mainframe terminal, andand more, for customers who want to analytics can be exploited by carriers. find it difficult to understand why there-engineer their claims department Accenture Claim Components can claims they process requires three, orwithout requiring the IT department to help uncover areas to reduce claims more, disparate systems (data capture,take on another project or reprioritize settlement expenses and increase financials and diary), as often happensother projects. This allows the claims recoveries, improving the organization’s today. It should be no surprise thatdepartment to work directly with a loss ratio. organizations that offer new, state-of-trusted business ally to service their the-art technology are better positionedclaims system in a world-class datacenter with high operational uptime. Priority 3: to attract and retain higher quality talent than companies that maintains Investing in the workforce antiquated tools.Priority 2: As every P&C insurer knows, attractingDeveloping Analytics and retaining good claims adjusters Old and non-consolidated platforms is increasingly difficult. While the also open up the possibility of employeeAdvanced analytics can be harnessed to errors, making career pitfalls and profession can be interesting andgreat advantage by claims professionals, failures more prevalent. For example, fulfilling, many claims systems seem tobut only if the claims systems can re-entering data into multiple systems make it harder, rather than easier, forhandle vast quantities of data from with separate IDs and passwords is not claims professionals to make the moststructured and unstructured sources. only time-consuming; it dramatically of their abilities. increases the likelihood of an error.The application of analytics in fraud Accenture Claim Components reduces One of the key requisites of a goodprevention and identification has or eliminates re-keying, automates claims system is an intuitive, easy-to-been well documented. Properly common processes and increases use user interface (UI). In addition toconfigured rules and automated review data integrity. The adjuster remains a well-designed UI, the claims systemof experience, based on years of past in the claims system, consolidating should automate the routine, manualclaims data, can improve the quality of information and interactions with tasks of the claims process to allow thefraud referrals and a higher likelihood of other systems, such as document adjuster to focus on the key elementsfraud prevention. Analytics can examine management for example. of investigation and settlement.unstructured data from sources such Predefined workflows and edits canas social media, for specific word assist every adjuster, but are particularly 6
    • About Accenture Claim About AccentureComponents Accenture is a global management consulting, technology services andAccenture Claim Components is a outsourcing company, with approximatelycomprehensive approach to claims 259,000 people serving clients in moreoptimization, designed to deliver a than 120 countries. Combining unparalleledclaims function characterized by experience, comprehensive capabilitiespremier customer service, a data- across all industries and business functions,driven life cycle, lower settlement costs and extensive research on the world’sand improved claims outcomes. most successful companies, AccentureProperty and Casualty insurers using collaborates with clients to help themAccenture Claim Components can become high-performance businesses andexperience a lower unit cost per claim, governments. The company generatedreduced IT costs, and the reinvention net revenues of US$27.9 billion for theof the role of the claims professional, fiscal year ended Aug. 31, 2012. Itsaccompanied by the creation of an home page is www.accenture.com.outcomes-focused culture. Theseinsurers can gain greater control Accenture Softwareof their business using carefully Accenture Software combines deepdesigned processes and workflows, and technology acumen with industryexperience increased speed to market knowledge to develop differentiatedfor new products and geographies. software products. It offers innovativeAccenture Claim Components raises software-based solutions to enablethe performance of claims handlers organizations to meet their business goalsthrough configurable, highly refined and achieve high performance. Its homebusiness rules and automated handling— page is www.accenture.com/software.all of which support the variationsinherent in the global insuranceindustry, without adding complexity.For more information on AccentureClaim Components, visit www.accenture.com/claims-softwareCopyright © 2013 AccentureAll rights reserved. 12-4237Accenture, its logo, andHigh Performance Deliveredare trademarks of Accenture.