Claims

Most insurers and reinsurers espouse a belief that new business doesn't always equal good business. To most insurance providers, the honeymoon period with a new customer ends as soon as claims activity intensifies.

Individuals who have experienced an auto accident or incurred damage to their vehicle often discover that the road to swift claims settlement is a bumpy, winding and volatile one.

Claims processing capabilities within the automobile insurance segment is not unlike a car itself-hitting on all cylinders is essential to ensure high performance.In 1999, Mayfield Village, Ohio-based Progressive Insurance Co. debuted TotalPro, a Web-based claims processing application that can be activated by both internal affiliates and Progressive policyholders.

As insurers' expectations for e-commerce revenue tumbled over the past couple years, e-business spending has focused on self-service initiatives such as enterprise portals and agent extranets. But most insurers lack the infrastructure and customer understanding to maximize the return on these and other technology investments, such as customer relationship management.Therefore, insurers need to create financial services hubs: technology platforms for delivering services that span multiple systems.

With the insurance industry, one moment of impact-whether it's two vans, two workers or two ships-can initiate a lengthy reporting trail weighed down by paper handling and delays. The first notice of loss, which carriers receive from agents by phone, fax, or Internet, starts the trail.

Some senior insurance executives have a hard time understanding how a seemingly esoteric technology such as artificial intelligence (A.I.) could possibly be used by the insurance industry.This mental juxtaposition is ironic because the potential applications are manifold. And more importantly, the insurance industry was one of the first to widely adopt artificial intelligence technology in the form of expert underwriting systems.

When Blue Cross Blue Shield of Massachusetts embarked on its customer relationship management (CRM) initiative four years ago, the Boston-based health insurer could find no other healthcare organization to use as a benchmark.Today, insurers thinking about implementing CRM would do well to examine Blue Cross Blue Shield of Massachusetts as a model for what can be accomplished with a customer-focused business strategy supported by sophisticated CRM technology.

With 2.4 million members, Blue Cross Blue Shield of Massachusetts has avoided the common errors of implementing customer relationship management (CRM).First and foremost, senior management decided in 1998 that the Boston-based company would adopt an enterprisewide, client-centric business strategy, which it calls Concierge Service Delivery.

Even though claims service provided by property/casualty insurance carriers represents a major factor in their ability to retain customers and attract new ones, insurers are not providing the level of service that is considered acceptable to corporate customers and consumers, two new studies conclude.Moreover, even well-capitalized carriers that possess the financial stability to support quality claims service appear to be dropping the ball.

HNC is widely recognized as a leading developer of analytic and decision-management tools. But are carriers ready to turn their important underwriting and claims decisions over to machines?The similarities between fighting terrorism and combating insurance or credit card fraud are not very obvious. However, the Bush Administration's Homeland Security initiative is considering using some of the same technology that's now being applied to identify fraudulent transactions for more than 300 million credit cards worldwide, and by nine of the 10 largest insurance companies.

In the beginning, Corporate America created a concept known as full-service, and it was good. The epitome of full-service is gasoline marketing, where a service station attendant rolled out the red carpet to customers, who could expect to have their tank filled, windshield cleaned, oil and tires checked and the transaction processed-all without unbuckling their seat belts.

Success in designing Web self-service capabilities does not subscribe to a "build it they will come" philosophy. The business sponsoring the Web site must first conduct diligent research to determine the specific blueprint of what Web features will be regularly accessed.BlueCross BlueShield of South Carolina was one of the first health providers in the nation to offer its members, doctors, hospitals and other health care professionals a large array of self-service transactional capabilities with real-time access to mission-critical information.

In today's highly competitive environment, financial services are largely a commodity, with institutions distinguished as much by service and price as by products and product features.Web self-service can significantly improve service quality. By automating much routine service, Web self-service enables users to quickly and easily resolve most of their service needs around-the-clock More importantly, because users aren't placed in a call queue for an available agent, Web self-service is often more responsive than contact centers.

Carriers and agents have invested a significant amount of capital toward electronic interface initiatives that enable the two parties to improve their data-exchange efficiencies and overall operational competencies.But as they carry this out, consumers have been neglected, to the extent that many "lack faith in the quality of online customer service," says Madelyn Flannagan, vice president of education and research for Alexandria, Va.-based Independent Insurance Agents of America (IIAA).

Environmentalists should be happy about the new document scanning and imaging system at Prudential Group Insurance-because it's saving a lot of trees. The insurer's disability insurance customers should be pleased too-because it's enabling the company to process their claims more quickly.What had been a manual, paper-intensive process of receiving disability claim documents via fax machine or mail has been replaced by a nearly paperless operation.

In the late 1990s and into 2000, several carriers and third-party providers began to recognize online calculator tools as invaluable in helping consumers perform needs analysis for life insurance."We have come to believe that few consumers have the patience or the understanding to spend a lot of time filling in forms to get the information they need," says Terry Burt, president of Canton, Mich.-based Interlinx LLC. Interlinx operates a Web site, www.budgetlife.com, that provides dynamic marketing and pricing data on a stable of life insurance products from more than 150 carriers.

Insurance is an important component of modern economic life. The logical outcome of the millions of policies in force today is a proportional number of claims to pay for covered losses.From an operational cost and policyholder perspective, the claims handling process is the heart of property/casualty insurance. It's true that performing risk analysis, selling policies and retaining customers are important issues for carriers.

It's easy to define what manufacturers produce and sell. Toy makers make toys. Auto manufacturers make cars. Pharmaceutical companies make drugs. But what do insurance companies do?

When Florida Combined Life decided to become a primary player in the dental PPO and fee-for-service business in that state, it had two major challenges: an aggressive timeline and an inflexible claims system.The Jacksonville, Fla.-based subsidiary of Blue Cross Blue Shield of Florida had been offering dental coverage as an ancillary product to its health insurance offerings, and it had been paying dental claims through its health claims system. But that system was inflexible, and would not meet the company's future needs, says Charles Brody, dental division vice president at Florida Combined Life.

Five years ago, Security Insurance Co. was suffocating under the weight of paper files. The company's file room was packed to the point where the company had to place file racks in hallways, consuming office space that cost $20 per square foot.Space constraints weren't the only problems that the Alpharetta, Ga.-based carrier's paper filing system created. Call center representatives had to put customers on hold and ask a file room clerk to retrieve the caller's file just to answer routine questions. Moreover, only one person at a time could work on a customer's file during the underwriting process, a situation that didn't foster high worker productivity.