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Fast path claims from IBM

A capability within the IBM Insurance Claims Solution Portfolio

Executive summary

Business view

Technical details

The goal

A smooth, swift claims lifecycle

Typically, insurers handle all claims the same—regardless of complexity. Studies have shown that the longer it takes to settle a claim, the higher the expense and loss payout in addition to increased chances of customer dissatisfaction. The fast path claims solution from IBM can help you address these issues with a streamlined process that segments the no- and low-touch eligible claims, pays them promptly and generates higher customer satisfaction. More importantly, it enables the insurer to focus the proper time and attention on complex claims and manage them more effectively.

The advantage

IBM can back up claims of expertise

Our fast path claims capability can offer your company a complete solution that includes IBM Business intelligence tools and best-of-breed ISV applications, running on IBM middleware and databases. We have componentized the claim value chain and extracted those elements that form the core capabilities that lend themselves to rapid claim processing. Our service-oriented architecture uses integration middleware to plug those components into a solution that yields our clients a substantial value proposition. We can also offer this solution on an outsourced basis where requested.

The benefits

Fast path equals satisfaction

Studies show more than 50% of customer satisfaction comes from the efficiency of claims processing rather than simply indemnity paid. New approaches and technology make it possible to handle up to 60% of claims with low- to no-touch management.

A comprehensive fast path claims solution optimises activities across your organization's entire claims lifecycle.

First Notice of Loss (FNOL) notification
- Claimants can report a claim 24x7x365.
- Claimant and policy information are automatically populated, reducing the time and effort for the claimant and/or agent.
- Automatic referrals for repair, replacement, rental and towing.
- System logic can identify these prompt payment opportunities.
- Automated checks and intelligence allow for early identification of fraud and potential recovery.
Assignment
- Through rules-based logic, low-touch claims are identified and automatically routed to an express claims handling group or referred to the field.
- Roles and responsibilities are redefined to optimise efficiency and capitalize on specific skills.
Setup and coverage
- Deductibles, locations and limits of coverage are promptly identified and applied.
- Statistical reserves or bulk reserves may be established automatically.
Contact
- Claims handler responds to the claimant within the tolerance of the company's best practice, for example, within two hours.
Evaluation
- Real-time integration with vendors and automated status updates for the claimant speed the settlement and enhance satisfaction.
- Rules-based logic determines handler authority levels and routes claims accordingly.
Settlement
- The settlement process is automated and payments are made electronically to claimants and vendors.
Management, supervision and review
- Real-time performance monitoring allows targeted training, appropriate reward and management of potential adverse situations.

The approach

From expensive to expansive

A national insurance provider wanted to replace their current legacy claims system with a Web-based solution that is flexible and expandable that would be used to handle simple, low and no touch claims. They were looking to implement a new process for segmenting their claims without interrupting existing customer service. In doing so, the provider hoped to improve customer relations and provide more user-friendly tools for employees to process these simple, low and no touch claims.

IBM offered a full claims transformation opportunity which incorporates several areas within IBM. IBM also created business-to-business and business-to-customer portals to connect claimants, partners and employees.
As a result, the provider realized:

Increased business flexibility with rapid updates to business processes.
Technically integrated expansion with the ability to easily add new partners.
Future growth potential for the company.
Increased speed-to-market by shortening development lifecycle.
Reduced development and system maintenance costs.

The financial advantage

Express is the key to your budget

More accurate and consistent claims processing can reduce both leakage and severity. Implementing our comprehensive fast path claims solution can help carriers:

Experience significant loss adjustment expense benefits with productivity improvements, often in the range of 25 to 50 percent.
Cut expenses associated with legal involvement and specialized adjudication.
Increase staff-to-supervisor ratio and reduce dependence on highly skilled claims processors.
Realize cost reductions through the centralization of resources and processing.

Next steps

Questions about this solution? Contact an IBM Financial Services specialist.

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