¿Cuáles son las mejores formas de mejorar la transparencia en el proceso de reclamaciones?

Setting realistic expectations in claims is more of an art then rattling off rehearsed procedures and regulations. You are creating a narrative to encompass the entire process while working in the details while keeping the audience engaged. One of keys to engagement is gauging your audience which will determine the verbiage and pace of the story. In my opinion, you have to tell the ENTIRE story of the claim process. The entire story including, explaining the investigation process, the possibility of 3rd party involvement, and the final resolution process. The less confusion in the process, the more comfortable the NI will feel with the resolution.

Carriers and IA firms require adjusters to contact an Insured within 24 hours of receiving the claim and to document the claim file with the conversation. This initial conversation is crucial, as it sets the tone for how the claim will be handled. Insureds are often skeptical and expect a difficult claims process, so it's important for the adjuster to reassure them by explaining the claim handling process, the adjuster's role in the process, frequency of contact, how the inspection will be conducted, and setting an appointment for the inspection. The adjuster should also inform the insured of their policy's deductible, as well as any endorsements or exclusions that may apply. The adjuster then must follow through with the expectations set.

I agree, Communication is the key. An example that I have come across in public forums is of CARE model - The Convenience Advice & REach model. Convenience by making it easy & quick for your customers Advice, keep it smart, add intelligence to the conversation by personalizing the info, leveraging some additional data points in real time. REach Omni channels, 24 × 7 availability.

Leverage digital tools and platforms to create an accessible and user-friendly claims interface. Online portals and mobile apps can empower policyholders to track the status of their claims, access relevant documents, and receive real-time updates.

Segmentar a los clientes según sus necesidades específicas de comunicación puede ser un diferenciador en un mercado competido. Por ejemplo, algunos clientes mayores quizá prefieran recibir actualizaciones por correo electrónico con todos los detalles. Otros más jóvenes podrían querer breves actualizaciones por WhatsApp. Identificar estos perfiles y personalizar los canales utilizados para cada segmento refuerza la transparencia al demostrar que la compañía se preocupa por satisfacer las preferencias individuales de comunicación.

Establish a feedback mechanism to gather insights from policyholders about their claims experience. Use this feedback to identify areas for improvement and continuously enhance transparency.

From my experience, explaining the insurance claim process clearly and in detail is essential. This needs to be done in a straightforward way that's specific to each claim. I recall a situation with an insurance company that was worried too much information might confuse customers. But actually, when we focused on making things clearer from the start, we found that fewer customers called back with issues. This was reflected in our first call resolution (FCR) rates improving, showing that better initial explanations led to fewer complaints, even when the payouts were less than what some customers hoped for.

Para reforzar la transparencia, yo sugeriría que además se utilice lenguaje simple y visualizaciones como infografías, líneas de tiempo o videos cortos para hacer la información más accesible y fácil de entender. Las reclamaciones suelen involucrar conceptos complejos como deducibles, exclusiones, límites de cobertura, etc. Transformar esta información en formatos más simples y digeribles para el cliente demuestra el compromiso de la compañía con la transparencia.

Soliciting feedback needs to be done throughout the claims process. If you wait till the resolution of the claim, regardless of the coverage determination, to discover the NI is confused about the process, you ultimately end up with a dissatisfied customer. In the world of metrics and customer surveys, this could impact your performance review regardless of how well the claim process was conducted.

El uso de tecnología como APIs o Data Analytics es clave para escalar la transparencia. En particular, recomendaría utilizar estas herramientas para detectar patrones y oportunidades de mejora en el proceso de reclamaciones. Por ejemplo, se podrían identificar los pasos del proceso donde hay más consultas o quejas de los clientes. O encontrar correlaciones entre el volumen de reclamaciones y otros factores como estacionalidad. Estos insights mejoran la transparencia al permitir abordar de forma proactiva los puntos débiles del proceso.

The journey of using technology to improve across claims life cycle starts with a. Identification of crucial areas in claims management. b. Understand how technology can complement business, for example to apply RPA, Robotic Process Automation, criteria such as larger numbers, monotonous process is considered with is seens in areas like loss reporting or payment and not very prevalent in areas like negotiation, special investigations, subrogation & salvage. c. Once the areas are identified, technology is on-boarded to enhance the system by tying it back to the problem resolution & customer centric support.

Inability to manage the core emotions effectively has earned insurance providers the reputation of being laid back and not responsive to customers. The elements of empathy & human touch along with apt communication in the training programs has become critical to drive the business well

The industry is constantly evolving, thus, training should be a focal point in all business models. Unfortunately, training does not add to the "bottom line" initially and appears to be often overlooked. Effective training does take time, resources, and may even hamper productivity at times. However, a well trained staff can more readily adapt to changing conditions as well as become more proactive in problem solving. Thus, allowing management to focus more on planning for the future rather then constantly fixing mistakes of the past.

Improve claims process transparency: 1. Clear Communication 2. Digital Platforms 3. Educational Resources 4. Transparent Policies 5. Proactive Notifications 6. User-Friendly Portals 7. Dedicated Support 8. Mobile Apps 9. FAQ Sections 10. Claims Workshops 11. Transparency Reports 12. Digital Documentation 13. Automated Updates 14. Feedback Mechanism 15. Claims Concierge Services 16. Transparency Initiatives 17. Training for Staff 18. Collaboration with Insurtech 19. Regulatory Compliance 20. Continuous Improvement. Enhance trust and customer experience through these measures.

Enhance transparency by educating policyholders about the claims process from the outset. Provide clear, accessible information on how to file a claim, what to expect during each stage, and the documentation required.

Transparency in the claim process is having dependency on both the parties involved- Insurer & Policy Owner/Beneficiary. 1. For simple cases, achieve optimized STP from minutes to seconds with the help of AI/ML, automation. Reduce customer complaints there. 2. For complex cases & tough communications, following can be helpful 1. Real time data integration from backend systems to front end system 2. Use Digital Ecosystem for the - Availability of policy language simplification to both insured/policy owner - Real time claim progress, Digital interactions through chatbots, FAQ's - Digital documentation - absolute quick way to show misrepresentation - Value added services for customer - quick connects for legal support, repair shops, etc.

Proactive education and defined costs with real life examples. Educate with the intention of eliminating uncertainty about how an insurance contract will benefit the consumer and the insurer. Define and highlight the costs most utilized. Provide real examples of how a claim would be treated based off the most common claims experiences.

- Customers appreciate quick and efficient claim processing. - Clear communication about the status. -Straightforward documentation requirements, and a hassle-free submission process.