Five Ways to Streamline Claim Handling

By Thomas Mulvey March 27, 2013

You could be getting more value from your insurance fraud detection software without spending another dime on technology. That’s not a bold statement, given the effectiveness of ISO ClaimSearch® and optional services, such as Decision Net®, ClaimDirectorSM, and ISO ClaimAlert: Foreclosure. The key is to change your perspective and use the tools to detect meritorious claims, not just suspicious activity. By using those existing services in a slightly different way, you can make your desk adjusters more effective. You can reduce cycle time, improve customer service, and retain policyholders while generating valuable word-of-mouth referrals.

Here are five ways to get started:

1. Use fraud indicators as merit indicators: The hunt for suspicious activity exists at one end of the spectrum — and identifying meritorious claims is at the other. In some cases, the same data elements you use in fraud detection can also help you identify claims that warrant faster disposition. Use the data in ISO ClaimSearch to build a profile for fast-tracking claims, and you can reduce cycle time significantly and increase fast-tracking thresholds to improve customer service.

2. Use third-party data effectively: The presence of certain financial stress indicators, such as foreclosure, can signal a heightened risk of insurance fraud. On the other hand, the absence of such indicators across a number of data elements may suggest the absence of risk. For a claimant with a “clean” record on financial stress indicators, the desk adjuster may be able to handle the claim with less investigation.

3. Score claims as they come in: In addition to using claim scoring to identify suspicious activity, you can use a service such as ClaimDirector to identify meritorious claims. Over time, you may be able to use your data to modify fast-tracking thresholds and drastically reduce both adjuster workload and cycle time.

4. Revisit fast-tracking thresholds: Evaluate claims settled above your fast-tracking threshold. You may find you could set the threshold much higher without assuming much incremental risk. The potential cost savings alone could be significant, possibly even taking points off your combined ratio. Using your existing analytics could simultaneously improve services while lowering expenses.

5. Never stop evaluating: Like fraud detection, meritorious claims detection can benefit from continual examination. New technology and techniques arise that can help you handle claims more efficiently and effectively. Investing in improvement over time can magnify your returns.

Register for regular e-mail updates now. >>


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.