Based on my 20 years of experience in general insurance services, the moment of truth is when a customer files a claim. It's a critical moment that can make or break their reputation. The customer is already in a vulnerable position, having suffered a loss, and relies on the insurance company to assist them in their time of need.
Excellence in claim services is, therefore, the moment of truth for general insurance companies. It's an opportunity to demonstrate their commitment to their customers and show that they are there to help them through difficult times. In this article, I will explore more about this issue.
The Importance of Claim Services
The ultimate goal of insurance is to provide financial protection to customers in the event of an unexpected loss. However, filing a claim can be complex and confusing, especially for customers who are unfamiliar with insurance policies and procedures. This is where claim services come in.
The Elements of Excellence in Claim Services
To achieve excellence in claim services, insurance companies need to focus on several key elements:
• Communication: Clear and timely communication with customers is essential. Customers need to be informed at every step of the claims process, including what documents they need to provide and what the next steps are.
Most customers are laymen. So, when communicating with customers, refrain from using completed insurance terms that would only worsen customer confusion and frustration.
• Timely responses are also critical when delivering excellence in general insurance claim service. The company should respond promptly to any queries or concerns the customer may have about their claim. This helps build trust and confidence in the insurance provider, as well as ensure that the customer feels valued and respected.
• Efficiency: The claims process needs to be streamlined and efficient, with minimal delays or errors. Customers should not be left waiting for long periods or have denied claims due to administrative errors.
• Empathy: Claims handlers must be empathetic and understand customer's situation. They must be able to provide reassurance and support during a very difficult time. Please bear in mind that customers are usually in vulnerable condition as they have just faced an unfortunate event. Always put yourself in the customer’s shoes.
• Expertise: Claims handlers need the knowledge and expertise to handle a wide range of claims, from simple to complex. They must be able to provide accurate information and advice to customers.
Fraud detection systems use data analytics and
machine learning to identify patterns and anomalies in claims data, allowing insurance providers to detect potentially fraudulent claims
When it comes to complex claims, it is necessary for the insurance company to engage independent and reputable loss adjusters, a consultant whose expertise is related to the issue of the claim, lawyers, and forensic accountants if concerning the business interruption and or huge claim on Stock of goods.
• Finally, continuous improvement is key to delivering service excellence in general insurance claim service. The company should regularly review its processes and procedures to identify areas to improve. This could include streamlining processes, improving communication, or providing additional training to staff. By continuously striving to improve, the company can ensure that they are always delivering the best possible service to their customers.
A Challenge from the External
While striving to provide service excellence in claim services, the insurance company also faces an external challenge, which is Fraudulent Claims. It is a significant challenge for insurance companies, and it can significantly impact on their bottom line. Fraudulent claims can result in substantial financial losses, as well as damage to the provider's reputation. To overcome insurance claim fraud, insurance providers can implement several strategies:
• Implement Fraud Detection Systems
One of the most effective ways to overcome insurance claim fraud is to implement fraud detection systems. These systems use data analytics and machine learning to identify patterns and anomalies in claims data, allowing insurance providers to detect potentially fraudulent claims. These systems can flag claims with red flags or suspicious activities, such as a high claim amount, multiple claims from a single individual, or claims inconsistent with the policy terms.
If the tools mentioned above are still considered a luxury, the insurance company could be simply set and implement a set of Fraud Indicators that serve as a flagging system for early detection of potential fraud.
• Train Staff to Identify Fraud
Insurance providers can also train their staff to identify potential fraud. The fraud indicators above can serve as one of the training materials for this purpose. Staff members should be trained to spot red flags and suspicious activities and to report them. They should also be trained to communicate with customers and ask questions to verify claims. This can help ensure that all claims are legitimate and that fraudulent claims are caught early.
• Use Social Media and Other Sources for Investigation
Insurance providers can also use social media and other sources to investigate claims. Social media can provide valuable information about claimants, such as their lifestyle, employment status, and social activities. By analyzing this information, insurance providers can verify the legitimacy of claims and detect potential fraud.
• Collaborate with Law Enforcement and Other Agencies
Insurance providers can also collaborate with law enforcement agencies and other organizations to combat fraud. These partnerships can provide access to additional resources and expertise that can help detect and prevent fraud. For example, insurance providers can work with claim investigators to investigate suspected fraud cases and prosecute offenders.
• Provide Incentives for Reporting Fraud
Insurance providers can also provide incentives for reporting fraud. For example, they can offer rewards or bonuses to employees who identify and report potential fraudulent claims. This encourages staff members to be vigilant and report any suspicious activity.
To avoid potential abused by the employees, those who reported potential fraudulent claims must be reviewed by the Committee, which consists of cross-function senior management. It must also be supported with solid evidence before those claims can be concluded as fraudulent claims. Excellence in claim services is the moment of truth for general insurance companies. It's the opportunity to demonstrate their commitment to their customers and show they are there to help them through difficult times. By focusing on communication, efficiency, empathy, and expertise, insurance companies can provide an excellent claims experience that benefits their customers and their bottom line. If we look at the service-excellent elements above, they are all about the human touch.
Insurance claim fraud is a significant challenge for insurance providers, but there are strategies they can implement to overcome it. By implementing fraud detection systems, training staff to identify fraud, using social media and other sources for investigation, collaborating with law enforcement agencies and other organizations, providing incentives for reporting fraud, and educating customers on fraud, insurance providers can detect and prevent fraud, protecting their bottom line and their reputation.
Customer Satisfaction and Overcoming Insurance Fraud is just like the gas and brake pedal of the motor vehicle. It all about balance and when to step on the gas or brake pedal in order to safely arrive at the destination. There is no exact or perfect formula. It depends on the company objectives and how long the “flying hours” of the Claim Management team have been through.
