Claims transformation: The inconvenient truth
Customers expect insurers to share information that illuminates the hidden dangers of their daily routines and to give guidance on minimizing the likelihood of adverse outcomes.
Claims is the beating heart of insurance service providers. It is the moment when insurers convert a policy into the financial help needed following a calamity, and it’s the point at which the sector proves its worth and makes good on the customer’s trust.
With such high stakes, you’d think insurers would do everything in their power to ensure a smooth, frictionless and stress-free claims experience. Yet, according to PwC’s Insurance Brand Sentiment Index 2022, something is going terribly wrong.
The index, which tracks the key drivers of compliments and complaints via social media, found that insurers experience more negative conversations on Twitter than positive, resulting in a net sentiment of -19.2%.
When you zoom in on claims, the numbers become even starker. PwC’s data shows that net sentiment for this critical event is -86.8%, highlighting it as a significant pain point.
According to the report, “…the approval or rejection of claims is the largest topic across the industry with customers unhappy with the outcome of a claim. However, customers are also voicing dissatisfaction with more basic operations such as claims status or delayed responses to questions.”
Moreover, claims dissatisfaction is a key reason consumers switch insurance providers. Accenture reports that nearly one-third (30%) of dissatisfied claimants had switched carriers in the past two years, and another 47% were considering it.
That data is damning.
Accenture says, “Overall, the consumers who reported not being fully satisfied could represent up to $34 billion in premiums annually, or up to $170 billion over the next five years.”
What is interesting is that insurance industry data suggests the opposite. According to the Association of British Insurers, 79% of home insurance, 87% of travel, and 99% of motor claims are fulfilled. Similarly, the American Council of Life Insurers (ACLI) reports that in 2021, companies paid approximately $100 billion to beneficiaries and another $97.7 billion to annuity holders in the U.S.
That begs the question: Why do consumers feel aggrieved when so many claims end in positive outcomes?
The answer is found at the intersection of two key areas: The failure to provide basic operations and timely responses, and the false perception that insurers don’t pay out.
With claims taking months or more to process and customers not being kept informed of where they are in the process, they can only assume they’ve either been forgotten, or their claim has been rejected.
The inconvenient truth
Despite all the talk of transformation, the inconvenient truth is much of what’s been accomplished is nothing more than Band-Aids. Some work has been done to digitize forms and offer a more user-friendly interface online, but the much-needed optimization and automation of the customer journey have been superficial.
Providing a “modern” interface that people can access via their computers and phones is essential, but it’s not nearly enough.
In reality, the entire claims process needs to be overhauled and automated. People expect intelligent, seamless and proactive capabilities integrated into their ecosystems. Voice-enabled, choice-based, personalized and multi-channel are not a panacea; they’re standard communication patterns for most of the world.
Putting the customer in control
The customer journey should be seamless from the moment a claim is logged. People should be able to self-serve damage assessments, valuations and settlement offers. They should be offered a choice of partners who can help them get their lives and businesses back up and running. They should also be able to speak to a real human when needed. However, as revolutionary as this would be, this kind of straight-through processing is just table stakes.
Customers now want their insurers to help remove the risk of a claim in the first place. They expect insurers to share information that illuminates the hidden dangers of their daily routines and to give guidance on minimizing the likelihood of adverse outcomes.
Insurers should be doing more to help people protect their homes from extreme weather and keep the costs of servicing their cars low. They could do far more to help people identify fire and health risks. Consumers know insurers have the data and technology available to do this. They want to know why they don’t share it and unlock this hidden value for both parties.
Legacy technologies are at their limit
Technology is where the fundamental failure of recent transformations comes into sharp focus. The problem is providing the kind of claims process needed is nearly impossible using modern legacy technologies that are the foundation of most of today’s insurance businesses.
They lack the flexibility, open architecture and data fluidity needed to build a claims ecosystem that prioritizes self-service. Despite the “modern” legacy moniker, existing insurance systems remain monolithic, complex and highly structured to the point that every change — large or small — is difficult, risky and extremely expensive.
It makes sense that insurers have concerns about wholesale transformation but trying to iterate on modern legacy won’t work either.
Integrating additional insurtechs, developing more API connectors and architecting hybrid cloud platforms won’t fix the root issue. They just result in eye-watering IT bills for every change that ultimately increases the complexity of managing the infrastructure and makes tech debt worse, not better.
Achieving true claims transformation
Claims teams can’t magically fix these deep-seated issues with the same old tools they’ve had for the past two to three decades.
They need new, modern technology to underpin their operations to achieve the necessary transformation. Technologies that will support better customer service, reduce claims leakage, eradicate fraud and leverage the abundance of data they have to remove risk.
They must move away from platforms that silo customer data around individual books of business and invest in an ecosystem future. While existing business models have focused technologies on maximizing distribution (treating digital channels as a sales opportunity only) and minimizing cost (in administration mostly), ecosystems come in two predominant forms.
‘Drivers’ look to maximize the knowledge of a customer and the ability to act on it, like removing risk. The key here is to treat the customer as the channel, which in turn means adopting ecosystem operating models that are data-fluid and intelligent.
The ‘modular producer’ is the other, which interplays with the ‘driver’ model. This is predicated on interoperability and ‘plug and play’ capability, which allows insurers to partner seamlessly to create value for customers. It also lets them partner with new and emerging customer ecosystems like Apple Health or integrate with a building management system.
The result is a future where technology creates a fundamental foundation for effective change, and every aspect of the claims lifecycle and the 360-degree customer view is adaptive. It ensures a system that allows insurers to tap into the best new data sources, supply chain management capabilities and insurtechs.
When insurers embrace this future, claims will no longer be a cost center. It will be a strategic asset that drives retention and customer acquisition. Treating claims as a strategic asset means investing in your ecosystem’s future, laying the foundation for continuous evolution and partnerships, automating fraud detection and reducing costs.
Rory Yates (ryates@eisgroup.com) is senior vice president of corporate strategy for EIS and has more than 24 years of business leadership experience spanning client, agency, consultancy, start-up and private equity roles. Yates helps insurers achieve their transformation goals and evolve toward ecosystem-based futures.
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