The High-Tech Claims Investigator

Depending on whose study you read, of all the money on the expense side of a carriers budget, between 65 and 75 percent of it goes to paying claims. Think about that65 to 75 percent, and that includes all the other things you have to pay for, like salaries, electricity, equipmentthe list goes on.That means, when you do the math, that a one-percentage reduction in the cost of claims means a lot more to the bottom line than, say, a one-percentage reduction in staff. That in mind, many carriers are realizing that money they put into claims technology can be an investment with significant return.Sure, there are toys you can buy for claims reps that are just thattoys. Everyone wants the latest Web-enabled cell phone/PDA combo with built-in GPS and full-color screen. But dont let the fact that there are toys out there scare you off from the real business toolsan investment in which can pay off quickly. (Its not the tools alone; you also need the right systems and workflow in place to take advantage of them.)Wireless technology is hot among road warriors, and claims reps certainly fall into that category. By some estimates, cell phone usage is expected to grow from seven percent of all domestic calls to 50 percent in the next four years.But wireless technology is more than just being able to call into the home office, or even to do basic Web browsing. In the claims world, PDAs are becoming communications devices, and have software that enables real-time connections to the corporate database. That means a claims rep on the road can whip out his Palm V and pull account information, cost estimates, and other information as if he was at his desk. The result is speedier action and happier clients.

Home FrontBack at home, a host of technologies are being deployed to reduce the billions of dollars insurers spend paying fraudulent claims. Expert systemsartificial intelligence, for all intents and purposesare being used to find the kinds of patterns that indicate fraud. This isnt the small-time fraud that so many individuals claim to have engaged in (Oh, and they also stole my other engagement ring), but the multi-million-dollar fraud rings involving unscrupulous doctors, corrupt lawyers, bad drivers, and all to often innocent victims.By analyzing the people, places, vehicles, addresses, and phone numbers involved in a claim, these products can flag connections that it might take an investigator weeks (and reams of paper) to find. Think of them as SIUs in a boxthey dont replace claims investigators and adjusters; theyre powerful tools for those people to use.Also at home, the claims process is being speeded up and automated. Better and better-designed workflow frees people from some administrative taskssuch as requesting information, working with providers such as doctors, inspectors, and repair companiesand allows them to focus on evaluating the claims that need a second look. That means less fraud slipping through the cracks.Various tools establish a more profitable workflow between claims and underwriting. Data analysis and statistical software can determine where the claims damage is being done and report back to Underwriting, which might adjust rates or recommend new policies or products.The end result of all these tools is simple: In the long run, if properly used, they can reduce the claims cycle time, cut fraud, and make the departmentand companya bit more profitable.For a more detailed overview of what todays and tomorrows claims investigators will be (or should be) using, this is the session you need to attend.