Automated Claim Process

Introduction

In the insurance industry claims are considered one of the crucial departments as they are responsible for all pay-out and compensation. Claim in the Insurance context is a compensation of a payment or reimbursement made to the claimant in favor of their request to be fulfilled by the insurance provider.

A professional claim assessor must be responsible to manually study the claim, approve, or deny claims in favour of the claimant. Additionally, a fair claim assessor must practice “Utmost Good Faith” when handling a claim case and be clear of any “fraud intention”. Sadly, due to huge amount of claims, possible intent to manipulate coupled with large amount of internal and external claims data, claim assessors as well as brokers are facing unprecedented challenges that make it difficult to support customers’ expectations specially in timely response. Pain points amongst others are in situations when there are delay in payout which results in repeat inquiries from claimant, high claim ratio due to manual human errors in claim processing, unable to process the claim due to insufficient documentation or even attempt to manipulate risk coverage that takes further time for investigation.

General Features of Insurance Claims Procedures

The actual claim procedure may vary according to the type of risk covered, benefits, claim amount and line of business either commercial, corporate, or small businesses. Agiliux’s automated claim process makes it easy and standardizes accordingly for organization of any size to manage claims seamlessly. Frontend mandatory checklist gives users ability to submit all necessary information and documentation completely before the claim can be processed.

Automation brings down the possibilities of manual human error and increases turnaround time with scalable ability to manage volume of claims at any given time.

Claim Form

Brokers need to submit all relevant documents with accurate information on a claim on behalf of the claimant. Automation of this process will increase timely processing of the claim, reduce risk of fraudulent submission, and increase efficiency of Broker. Any claim form generally has two 2 sections:

• General information such as name of claimant, type of cover, contact information and policy number. These are important requirement for the broker to proceed and to ensure claim is done for a policy that is enforced. Agiliux helps to ensure details are accurate based on their existing claimant profile.
• Detailed information of the loss such as type of loss, third party information, place of occurrence, supporting doc include photo and date of loss. Agiliux digital submissions allows for complete mandatory documentation uploaded fast and easy by claimant.

Claim Processing

Agiliux can ensure an aligned process for claims with a set of document checklist attached as required or customized, to complete the end-to-end workflow. In certain insurance classes the claim assessor can retain a loss adjuster if a complex claim is involved. Loss adjuster usually will physically examine the loss and identify the causes of loss then decide the severity of loss based on the risk covered in the policy. Loss adjuster can input in the same workflow process of the findings and recommendation. Agiliux can capture this information input digitally from the loss adjusted in real-time, either via web or mobile. Agiliux has the capability as well as the ability to automate payment integration links with payment gateways in the market, that will update payment pay-outs.

The Challenges Faced in Claims Management

Over the past years the insurance industry has been exposed to various digital platforms and gradually some have started to get on board with automation. However, with the operations of legacy systems still in play, many brokers who have been in the insurance business for a long time find it a real challenge to change mindset or quickly make this paradigm shift to digital automation. For many years, the insurance industry relied on manual claim processing using high number of human resources as they could not find the right automated technology that supports end-to-end claims management. This means high labor cost and high error rates are unavoidable. Although there has been significant technological break-throughs that can improve efficiency, not all platforms have accurate claims resolution through data analytics and decision-making capabilities which in turn creates dissatisfaction amongst users.

Brokers are looking for a platform that can deliver measurable business results via analytics and a system that can reduce redundancies. Claim processing should be relatively straight-forward especially in today’s digital age where automation can provide accurate analytics while freeing broker time and resource to manage much more complex matters. 

Opportunities for End-to-End Processing

The claim process can be considered as one of the most common and time-consuming workflows. Therefore, brokers have taken initiatives to improve the customer experience and streamline the claim processes. It is good to note that 80% of the brokers have begun to automate their business; however, some are still using outdated software when it comes to claims management. A clever move to Agiliux automation in claims management will allow for budgets to be freed up towards more innovative adaptation in the business, while driving broker business forward strategically to gain better customer experience with increased efficiency and proper utilization of resources.

Agiliux Can Streamline and Automate Your Claim Management

Agiliux was designed to accommodate your current system and to comply with the ever-changing digital transformation to be future-ready. With strategic and continuous growth, the system is tailored to cater for compliance-based business processes and workflows.

Agiliux delivers functionality that manages all risk and claims practices that includes powerful analytical tools from the First Notice of Loss (FNOL) to the settlement.

Optimistically the ability to integrate with insurance companies or other vendors, helps to achieve end-to-end claims processing within a single solution. Agiliux provides speed, agility and accuracy in claims.

Agiliux will streamline your entire claims environment. No more papers or manual processing or switching from screen to screen. Key features are:

• Register or report the claim to the system.
• Adjustment towards claim reserve, outstanding loss and settlement.
• Ability to upload all claim related documents.
• Claim status update at a fingertip (report, in-progress updates).
• Preliminary loss advice, settlement and repudiation.
• Module for adjuster is available for the claim processes.
• Report automation that can be sent via email for analytics, pending documents or settlement of claims.

Conclusion

Agiliux automation will expedite claim processes, align a smooth compliance-driven workflow and increase accuracy with a faster turnaround time to end-users; all within a secure cloud base platform. It is time to upgrade your legacy systems and move forward with a digital purposed based solution for insurance that Agiliux offer.

Next Step

Soft Solvers Solutions brings you a total insurance solution with Agiliux being the flagship for the insurance industry. Today, Agiliux can manage over 14 million active policies for 6 countries within Asia Pacific since its inception. Agiliux has become one of the fastest well known InsurTechs in Malaysia.

Find out how Agiliux can support your immediate and long-term goals for cloud software. Book a demo with us.

Learn more at www.agiliux.com