PwC advises insurers to outsource claims ‘where appropriate’

PriceWaterhouseCoopers LLP is advising insurance companies to integrate advanced telephony systems with their claims systems, to “share talent” with large groups of claims adjusters and to use analytics to understand their customers’ patterns of behaviour.

PwC’s financial services (FS) industry group in the United States recently released a report, titled “Claim to fame: Positioning the claims function for operational excellence,” in its FS Viewpoint publication. The consulting and audit firm noted there are “five dimensions” to a successful claims transformation.

One is the operating model.

“Build efficiencies of scale where possible by sharing talent among larger groups of adjusters with specialized skills to allow for better internal work balance and sharing among adjusters,” PwC advises. “Outsource where appropriate to deliver high-quality service to claims customers while maintaining due focus on the core business.”

Another dimension is advanced technology.

“Ensure that the new claims system is connected with other systems (such as policy administration) to share data across the organization,” PwC stated in the report. “Implement advanced telephony integrated with the core claims system to track data from customer interactions.”

Information and analytics, another dimension, involves getting to know customers, their expectations and patterns of behaviour.

One leading insurer uses “third-party fraud frameworks within special investigative units, resulting in increased efficiency and accuracy by preventing, detecting, and managing claim fraud,” PwC said in the report. The un-named insurer also partners with “third-party data providers to provide real-time data (such as geospatial, workers’ compensation injury reporting) that is integrated into insurer’s claims operations.”

The “customer experience” dimension of a successful claims transformation entails minimizing “the number of touch points” that customers need.

“When customers interact with your company, it should feel seamless,” PwC said. “Make sure your operating model can support that experience.”

One “leading insurer” gives their policyholders “mobile applications that provide information, tips, and tools needed in the event of a claim,” PwC noted in the report.

The fifth dimension, integrated management, involves integrating the claims function with other departments in the company, PwC suggested.