Insurance: Claims Management

Improve the efficiency and effectiveness of your claims decisions

Many insurers have recognized the need to improve the efficiency of their claims management process. They have streamlined processes, eliminated paper-based forms and redistributed work to match the demands to skills. The objective of their efforts is to lower costs, while also increasing overall throughput.

Efficiency improvements make tasks quicker and less costly to execute. However, to realize even greater improvements in the claims handling process, insurers must also focus on the effectiveness of their claims decisions.  Claims handling costs typically represent 10% to 15% of net earned premium; in contrast, claims payouts represent 40% to 65%. Insurers that expand their focus to include effective as well as efficient claims processing will find a far larger pool of savings opportunities.

To that end, Enterprise Decision Management (EDM) for Claims Management helps insurers:

  • Properly set reserves to maximize capital efficiency
  • Pinpoint fraudulent claims to avoid and deter false activity
  • Identify opportunities for subrogation and salvage to recover losses and forgone asset value
  • Consistently apply policy terms and conditions to eliminate unwarranted payouts

Illustrative savings that have been attained through EDM for Claims Management include:

  • Identified opportunities to improve subrogation collections by 35% to 50%
  • Reduced losses due to fraudulent claims across multiple lines of business from 20% to 50%
  • Reduced loss-adjustment expense by 20% to 25%
  • Allowed carrier to automatically review potential for fraud in up to 6 million claims per year

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