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Claims transformation from IBM

Executive summary

Business view

Technical details

The goal

Customised claims transformation

It's not just the size of the settlement, but a prompt response that keeps customers coming back. And with 80 cents of every dollar your company takes in flowing through your claims operation as indemnity or expense, it is a logical place to find opportunities to cut costs and streamline operations. To this end, IBM offers proprietary methodologies and open standards tools developed by seasoned claims professionals.

The advantage

On demand assurance for insurance

To address the unique industry challenges facing insurance companies today, IBM has:

More than 15,000 global employees dedicated to insurance—the largest combined IT and business infrastructure and services organization serving the industry.
Global, national and line-specific insurance alliance partners who provide leading application solutions and expertise.
A broad set of IT offerings including scalable, reliable technology that eases integration and performs according to on demand standards.

The benefits

Aligned claim complexity throughout value chain

The tools and methodologies in the claims transformation solution capitalize on unique benchmark and maturity information assembled specifically for the claims area. IBM can help you make intelligent choices in how and where to leverage skills and resources for the greatest bottom line contribution.

Claims strategy and target operating model
- Defines a "target business competency map" through IBM's Claims Component Business Modeling (CBM) by mapping target business capabilities onto defined components.
- Articulates a clear end-state vision for claims and translates it into a practical target operating model.
- Enables you to plan and build a coordinated representation of claims to achieve the full transformation benefits using claims component business modeling (CCBM).
Claims capability assessment methodology (CCAM)
- Provides a standard methodology that can consistently measure the capabilities across your organization's people, processes and technologies.
- Develops a high-level business case for pursuing initiatives to address key gaps uncovered in the analysis.
Claims file analysis (CFA)
- Highlights the existing baseline for leakage identified and analyzed across major dimensions including process stage, root cause and size of claims.
- Acts as first step in sizing loss cost opportunity and allocating that opportunity to the appropriate, phase, root cause, best practice and initiatives to drive operational change.
Claims task analysis (CTA)
- Allows your claims organization to understand where and how much time and expense is spent on all activities involved within the claims enterprise.
- Underpinning this methodology is the CTA tool (questionnaire and databases) for the collation and analysis of data.
Claims process analysis and design
- Structured process design and gap analysis methodology and templates for defining as-is and to-be processes.
- Dynamically documents detailed process flows and analyzes multiple scenarios.
- Supports other tools and methodologies including workload and staffing models and industry best practices.

The approach

IBM helps reduce cycle time and improve service

A U.S. auto insurance company serving more than 10 million drivers is known for technology and innovation. The company's claims workbench application is installed on 5,000 laptops and uses wireless technology to settle claims with speed and accuracy. Management wanted to update the company's middleware platform for wireless data transmission with open, scalable platform for emerging requirements.

IBM provided a wireless-enabled solution based on IBM WebSphere Everyplace® Connection Manager, WebSphere MQ Everyplace connectivity software and ThinkPad® computers. A cluster of IBM eServer pSeries® servers and an IBM eServer® zSeries® processor support wireless technologies in a way that is transparent to users, while offering a flexible, open standards base for the future.

The company enjoyed a variety of boosts to its performance as a result.

Transaction cycle time has been reduced.
The cost of doing business lowered.
24x7 customer service has been improved.

The new design is more streamlined, scalable and ready for growth. The new platform has fewer failure points and a seamless failover capability.

The financial advantage

Free up resources. Focus expenditures.

What can your enterprise expect from the claims transformation offering from IBM? We can help you realize:

Reduced overall claims cycle time.
Increased productivity through workflow improvements and integrated access to multiple types of customer claims information.
Redistribution of people and skill alignments.
Reduced need for expenses associated with specialized adjudication.
Increased subrogation and fraud identification and capture.

Next steps

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

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