Utilizing digital technology to empower claims adjusters

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More insurance companies are investing in modern digital technologies to reduce their costs, increase revenue and stay competitive. In fact, the top sources for cost reduction among insurers today involve digital transformation, technology modernization, and data and analytics, according to a recent Accenture survey of global equity analysts. That compares to the rush by insurers to pursue third-party outsourcing or offshoring models to cut their costs in prior decades.

One proven way that insurers can embrace the new trend for a digitally enabled operating model is to give claims adjusters in the field better tools and capabilities to perform their jobs more effectively. The professional life of a claims adjuster involves a challenging series of processes to assess new claims, gather the necessary documentation, and execute actions to resolve a customer's case. Each step along the way requires due diligence and close attention to detail, and that is where technology can help.

The core role of any adjuster is to inspect for property damage or personal injuries and determine how much compensation the insurer should provide to cover the losses. The initial discovery process involves interviews of claimants and witnesses, along with an inspection of the relevant home, auto or business. Adjusters must also do additional research to review any video evidence or police reports. Yet once the case has been fully documented, the adjuster is just getting started on the path towards remuneration and closing the case.

Technology can be used to support adjusters through each step of the claims process with a new kind of digital platform that acts as a support layer on top of the software applications. Such a digital adoption platform guides claims adjusters toward the desired process results while eliminating costly human errors. There are several key areas where a digital assistant can improve an adjuster's efficiency, including performance support, claims processing, regulatory compliance and claims leakage.

Enabling performance support
Processing workers' compensation claims involves navigating the many intricacies and distinctions of each state's unique insurance regulations. This analysis can become overwhelming due to the high variance among laws from state to state, which complicates the task for adjusters who need to keep track of each state's different procedures and timelines.

For this reason, many teams have stored documentation for 50 different state regulations on an unwieldy shared drive that lacks complete accessibility, making it difficult for users to quickly find what they need to resolve a case. As a result, manual searches frequently cause errors for workers' compensation claims, driving up costs from rejected claims, failure to meet compliance statutes, or customer churn due to poor policyholder experiences. Digital platforms can minimize these error rates.

Improving claims process efficiency
Another area involving a high error rate stems from customer service representatives who gather input from customers during the First Notice of Loss, or FNOL. The reps often lack certain critical information from customers to process their claims efficiently, but a digital platform can identify error-prone instances and suggest solutions.

For example, the smart agent can auto-fill vehicle information to properly calculate claim limits based on coverage details. In this way, customer service reps get smart nudges to be more productive in ensuring that all the required data is accurately provided.

Increasing regulatory compliance
Claims adjusters are often unaware of periodic changes or updates that are made to state laws during the claims settlement process. A digital agent can keep them updated automatically. For example, the updates could guide adjusters through homeowner cases affected by new mandates in California law that address wildfire risk assessments, or earthquake damage protections.

Reducing claims leakage
Every insurance company seeks to reduce its claims leakage by minimizing insufficient documentation and process inconsistencies. This may lead to a high number of litigation cases and related expenses.

Analytics software can help identify such erroneous processes, while digital platforms give adjusters a smart nudge and data validation to ensure that all the required information is included for pre- and post-investigation.

In the end, insurance claims adjusters are people, and all people are fallible human beings. Digital platforms can empower claims adjusters to become more accurate and make better decisions in their processing roles. In doing so, they can help make their companies more profitable on the way to a successful digital transformation.