Accurate and efficient processing of claims has been a critical component of the profit equation in the insurance industry since its inception. Early automation efforts primarily addressed the accounting and reporting aspects of claims operations. As systems have become more sophisticated, the emphasis now is focused more on how the work gets done.

Streamlining processes and improving efficiencies aim not only at reducing costs. Today, automated systems have the power to transform claims operations by taking business capabilities to the next level: improving the quality of decisions; enhancing the customer experience; and integrating claims functions to create an environment for collaboration throughout the organization as well as with third-party service providers and stakeholders.

A recently released SMA research report, Claims Transformation—Positioning for the Future—identifies the accomplishments insurers have made and looks at where new investments are being directed. Insurers are making great progress and formulating significant plans to transform their operations for success in the coming years. They are continuing to focus on efficiencies but are taking a broader view of how to transform processes for real advantage in the marketplace.

Insurers are investing to equip their professionals with the information they need to make better decisions; automating to better satisfy customers during the claims experience and retain desired clients; and spending to improve accuracy and reduce cost.

For many, the greatest barrier to improving claims processes is having existing IT platforms that fall short of meeting their business needs—systems that are isolated and insulated and depend on scarce IT resource for all changes.

The key capabilities that insurers are looking for in their next claims-administration systems include workflow, no- or low-touch processing for routine claims, document management, and business intelligence. Investments are being directed to capabilities that make it easier to respond to new regulation, to drive efficiency via a paperless office, and to position for a better response to catastrophic events.

Insurers are planning to invest in imaging technologies and automated workflows to improve efficiency and foster integration with service providers and specialized servicing systems for areas such as fraud and medical.

Keeping the pace in the claims space is a must for success in the coming years. The claims area can make significant contributions to transforming the overall business. Insurers need to examine their own operations in light of what is quickly becoming standard practice in the industry—capabilities that only a short time ago were considered bleeding edge. If it isn't already in the works, it is time to develop a thorough plan for claims transformation—to expand both thinking and action beyond the transaction.