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Finance & Insurance

Optimized claims processing system for 22 million customers

How do you talk to customers when they won't pick up the phone?

Among millennials, 75% are prone to ignoring phone calls. In a world where phones are increasingly used as computers and increasingly not used as telephones, this is not surprising. Traditional businesses such as insurance carriers are discovering that they have to modernize their approach in order to effectively reach the modern consumer.

Client's Challenge

Our client's claims settlement team recognized a need to rethink their approach to customer communications, both to better support the customer and to optimize the company's claims settlement practices.

According to a key executive working at the client's side, the traditional process of claims settlement is the most "cumbersome" and "time consuming" part of a customer's interaction with their insurance provider.

The challenge has multiple dimensions. First, there was a need to simplify the claims settlement process and make it more customer friendly. Second, there was a desire to boost customer loyalty and engagement overall. Third, there was the requirement for internal operations to be more efficient and productive.

Was it possible to build technology that would make life easier for both the customer and the organization?

Clurgo's Solution

On the UX/UI side of the equation, the team designed a web and mobile experience that was tuned to the customer's preferred journey. Claims could now be submitted at any time and from any location via an intuitive and fully automated wizard.

On the back end, we worked with the client to streamline the business process and then built a fully automated system that intelligently routed claims to the appropriate systems and departments for review and disposition.

The integrated front end and back end capabilities resulted in a platform that met the established objectives and offered both the customer and the organization an optimized experience.

First, the customer files a new claim through web or mobile. The new claim is processed and a unique claim link is provided to both the claimant and the at-fault party. Information is automatically requested from the two parties as needed. The platform automatically verifies eligibility, checks fraud scoring, downloads relevant law enforcement data, and generates an expert analysis request as needed. With data collection complete, the platform checks against specific rules and criteria and either approves the claim, denies the claim, or pends the claim for human review. Additionally, the platform dynamically updates balance sheet reserve requirements to match pending claims. Once the data are collected, the system runs them against pre-set criteria and decides on one of three outcomes. If the criteria are met, the compensation gets paid; if they are not, it is denied; and in rare instances of inconclusive results, the case is forwarded to a human for further inquiry. Additionally, the system dynamically updates the size of client’s balance sheet reserve to match the sum total of all the pending claims at any given moment. This makes the company’s budget more flexible because the reserve expands and contracts, freeing up resources when it does the latter.

Results & Benefits

  • With the deployment of Clurgo's platform, the client saw a massive increase in efficiency. 85% of claims were auto-resolved in just 1 day rather than the 4 days and significant manual intervention that was required previously.

  • Customer satisfaction increased dramatically as customers could now file a claim at any time and not have to go through a time-consuming phone resolution process.

  • Overall, the process became not only far faster but also more transparent. The automatic adjustment to financial balances made more capital available for both capital and operating expenses, making the business more nimble - a significant accomplishment given organization's size.

Do you have a business need related to process automation, CX improvement, or insurance applications?

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