By: Anuradha Kuttan and Kesavan Senthamilselvan

Claims are an important value chain component of business through which customers/ beneficiaries realize the commitment of the benefits provider. Essentially, it is the moment of truth. Ensuring that customers/ beneficiaries have an enhanced experience throughout the claims process is a key priority for employee benefit providers. Benefit providers are looking at transforming their claims experience to achieve customer satisfaction, make processes efficient and prevent or minimize claims through digitization, legacy modernization, IoT, intelligent automation, and analytics.

Digitization – Benefit providers are transforming their digital capabilities to provide self-service options for claim submission and tracking. Through digitization, they are enabling faster processing of claims starting from submission to settlement, and providing ‘anytime, anywhere, any device, any service’ capabilities, thus ensuring a hassle-free experience when the customers are in crucial situations.

Legacy Modernization – The legacy claims systems may not be able to meet the customer expectation of faster claims processing. Legacy modernization is a key initiative that can help benefit providers address the imperatives of faster, simplified, and streamlined claims processing. Benefit providers are adopting different strategies based on their goals, which are initiatives like replacement of core systems, lift and shift a stack of applications to a different platform, outsourcing of applications to third parties, etc.

Internet of Things (IoT) – Benefit providers are looking at leveraging IoT interventions to mitigate the number of claims. Providers are delivering value added services such as wearables, to monitor health-related information and promote healthy lifestyles, mitigate health related risks, improve employees’ physical and mental health, and reduce claims. Data collected through these devices can help employee benefit insurers determine risks progressively and precisely, thus aiding the claims process.

Intelligent automation – Employee benefit providers want to reduce processing time and expenses, and enhance customer experience across the insurance value chain, which also includes the claims business area. This can be achieved by implementing automation in claims processing, which will eliminate laborious manual processes.

Analytics – Analytics facilitates employee benefit insurers to make informed decisions. The analysis of claims data will provide an understanding of the claims pattern and high-cost claims, based on which, plans can be designed, customized coverages and tailored pricing can be offered. It can also help in identifying fraud, education needs, and any redundant processes that lead to increased costs.

Here are some examples of initiatives across digitization, legacy modernization, IoT, automation, and analytics undertaken by benefit providers:

1. A leading supplementary benefits provider launched a policyholder app for superior claims experience. The mobile app was an instant hit among customers, and led to about a million downloads and a huge claims submission in one month, while they were also able to fulfill the ‘same day claims settlement’ promise.
2. A leading US insurer launched a group web portal that helped members and brokers with a variety of self-service options to initiate claims, view details, and upload/download documents for faster processing, thereby providing enhanced customer experience. The self-service adoption increased by around 40% in a year.
3. A leading US insurer with a significant group portfolio had a legacy admin platform that did not support self-servicing capabilities. Also, there were a lot of manual efforts involved in the process of enrollment, claims, forms management, and correspondence generation. They migrated to a COTS group admin platform to provide better customer experience, and faster turnaround times for processing group enrollments, servicing, and claim requests.
4. Beam, an American dental insurance provider, uses IoT technology to offer dental insurance. They provide a smart toothbrush that tracks a customer’s brushing pattern and how they take care of their teeth. The smart brush collects the data and provides customized insurance plans based on the teeth brushing data and pattern. The firm claims that it could offer rates that are 25% cheaper than competitors using IoT and data analytics. With the help of the smart toothbrush, they will be able to mitigate claims.
5. John Hancock, in partnership with Vitality, started providing Fitbit devices to their customers free of cost. Through the device, they were able to monitor the health parameters of customers and helped them to stay healthy. In addition, they also incentivized customers with several rewards, discounts, etc., which made their risk profile healthier and ultimately provided a better claims experience
6. A global insurer is taking an automation and cloud first approach in all areas with a focus on reducing operating costs. They are implementing an AI/ML-based no-touch claims processing.

Conclusion

Benefit providers must understand customer expectations and identify themselves as a true partner capable of engaging with claimants empathetically and meaningfully all through their claims journey. To realize this, benefit providers must focus their energy towards assessing the current processes and systems to understand the areas of improvement needed in the processes and technology to converge on transformation initiatives. Benefit providers may have different levels of maturity in their claims experience and hence, should identify an appropriate approach that will lead to success in transforming the claims journey.

LTIMindtree has helped a leading supplementary benefits provider in bringing about policyholder experience transformation by implementing a policyholder mobile app with claims management capability. The modernized mobile app makes the claims management process seamless. It is a hybrid solution, which helps in simplified claims management – filing claims, status tracking, claims-related communications, and document upload/ download for enhanced claims experience.

LTIMindtree’s deep insurance domain knowledge, technology expertise, and proven record in policyholder experience transformation can help deliver superior customer value through claims transformation.

For more details, read through this case study.

References

1. https://www.insurancethoughtleadership.com/claims/gateway-claims-transformation
2. https://www.ey.com/en_us/insurance/change-for-the-better-the-future-of-worker-benefits
3. https://assets.ey.com/content/dam/ey-sites/ey-com/en_gl/topics/insurance/insurance-pdfs/ey-nextwave-insurance-life-retirement.pdf\
4. Trends Report on Employee Benefits, 2022, Mindtree