Generali

Claims management is essential to the value that insurers deliver to customers. A positive experience results in greater trust which at Generali goes to the heart of our Lifetime Partner ambition. In today’s context, technology has opened up a new horizon of possibilities for approaching claims management. From remote inspection to fraud detection digitalized processes are increasing efficiency, mitigating risks and creating a more customer-centric claims experience.

Yet human touchpoints remain critical to our success, which in the digital era makes ensuring our technological innovations don’t supplant the empathy and understanding that our industry is built on all the more important.

Think Digitally About Claims

Digitalization and the implementation of advanced technologies have already made significant progress in improving the speed of claims processing. At Generali, our approach has been to adopt systems that can help increase the productivity of our people and enable seamless interactions with our customers.

This brought us back to basics where we designed a more customer-centric approach to claims from the ground up. For example, to start we created a digital self-service portal and a related app to enable our customers to efficiently submit claims, upload documents and check progress at any time. Upon receiving a claim, we now deploy optical character recognition to capture the data from the documents that were uploaded and use Robotic Process Automation (RPA) to speed up routine manual tasks for assessment.

In the area of non-complex health claims, we use straight-through processing (STP), a fully automated yet accurate claims process that has removed the need for human intervention. This reduces the time it takes to resolve claims from days to hours, a massive benefit for our customers. In cases where STP is not possible, analytics software is used to prepare a preliminary claims assessment result for a human examiner to review—a hybrid process called auto-adjudication.

Analytics are also being used for fraud detection, categorizing questionable claims and flagging those that may involve inauthentic invoices and documentation as well as instances where duplicate claims are submitted.

Put a Strong Strategy in Place

Getting the most out of these digital capabilities requires a comprehensive strategy that brings collective capabilities together for the benefit of customers and the enhancement of internal operations.

For example, in one of our markets in Asia where the insurance companies all use a single third-party administrator (TPA) for claims, we’re able to apply our auto-adjudication strategy as well as fraud analytics to streamline assessment and review. This works by automatically identifying any discrepancies between the claims received from the TPA and our system, and then flagging them for manual examination.

Human touchpoints remain critical to our success, which in the digital era makes ensuring our technological innovations don’t supplant the empathy and understanding that our industry is built on all the more important.

By automating the approval of claims that are deemed clean, we can maintain quick turnaround times while allocating valuable human resources only to those claims that have been sent for further investigation.

Anticipate challenges

While technology is certainly enhancing the claims process, challenges are also emerging that are unique to today’s context. For example, in many markets worldwide there is no standardized invoice providing data for health claims, which can limit data accuracy and hinder the effectiveness of analytics.

Local market regulations in areas such as data privacy can put constraints on how claims solutions are designed and implemented. Given how quickly these regulations can evolve, sensitivity is needed when making decisions about how to use data for claims management.  

Another important element is around customer expectations. Although digitalization is helping in many areas, claims are still an uncertain process for customers. Investigations can be complicated and time-consuming, and while they can check on the status of their claims at any given time, customers are unlikely to receive the level of assurance they desire.  

This brings into view the indispensable role of human interaction and personalized services – especially when claims are complex.

Don’t forget the human element

I’m confident that nowadays digitalization is necessary but not sufficient for holistic claims management. Necessary because of the undeniable gains in efficiency, effectiveness and resource management, but insufficient in that insurance remains, at the bottom, a human-to-human industry. When claims are submitted, loss has occurred and we need to be there to journey with our customers during this time.

This requires talent that understands the needs of customers during the claims process. It also demands that we remain accessible for questions and proactively reach out with support when it’s appropriate to do so.

My final point would be to underscore that insurers are operating in an exciting new context, where our fundamental value is being communicated in vastly different ways. Staying attuned to the challenges while embracing the opportunities is how we’ll continue to grow with our customers in the months and years to come.