2016 Claims Preview

By Thomas Mulvey September 8, 2015

“Point of claim” revolution will push fraud analytics upstream

Looking ahead to the state of claims in 2016, one of the most significant trends in claims processing will be a new emphasis on information, analytics, and decision making at the “point of claim.”

The workflow of the first notice of loss (FNOL) has traditionally started with the collection of cursory loss scenario information. That information is then added to internal documentation about risk coverage and loss history and handed off to an adjuster.

It’s the handoff point that is being reimagined. In the near future, the point of claim — namely, that first moment of contact with a claimant — will be transformed through significant intelligence gathering and the application of advanced analytics.

The industry is beginning to recognize the huge benefit in pushing claim analytics further upstream in the claims-processing function. The change will be facilitated by resources that can be pinged in real-time — at the point of claim generation — while extensive internal and external loss history analysis results are completed.

In 2016, FNOL will transform into a more refined discipline with a new mission. Rather than intake center representatives rushing off the call or the website automatically processing the claim report, the rep or the website will maintain contact with the claimant while instant analytics run in the background to verify legitimacy and accuracy. This immediate flood of data will serve as a new source of intelligence, creating the opportunity to make claim decisions during the first contact.

The technology trends that will fuel the point-of-claim revolution are:

  • predictive modeling’s improved functionality
  • big data’s ability to be put to better real-time use
  • advancements in claims-scoring tools
  • availability of more data sets, including aerial imagery, license plate locators, device reputation screening, and social media scanning

One of the first benefits in the FNOL transformation will be an expansion of quick or instant settlement parameters. As the industry experiences this transformation, we can expect a positive impact on severity, loss adjustment expense (LAE), and customer retention. In addition, the new streams of decision support information will improve reserve setting.

With instant intelligence and rapid-resolution decision making, in 2016 and thereafter, claims intake will expand beyond a primary report and evolve into an integrated, multifunction analysis resulting in a higher percentage of fast track resolutions.


Thomas Mulvey

Thomas Mulvey has been in the business of insurance investigations for more than 27 years. In his current position, he serves ISO as assistant vice president of SIU and claim services. He is also the coordinator of ISO’s Insurance Fraud Management Conference.