Claims management in insurance has great potential for automation. Two factors are important: fast communication with the client to provide support before the claims process is opened and the processing of the claim. The insurance software from ACTICO helps companies automate internal processes and the interaction with the affected parties to a great extent. The ACTICO Rules software makes automated decisions on the basis of business rules. This allows a high percentage of claims to be processed automatically.
Clients expect their insurer to respond to their claim almost in real time. Automating claims settlement makes it possible to fulfill this expectation.
Automated processes support insurers in assessing the amount and the obligation to compensate (e.g. by checking whether the premium covers the reported damage).
Automated claims management reduces costs, since claims must be processed by the claims manager only in exceptional cases.
As soon as a customer reports a claim, the claims manager estimates the cause, scope, complexity, and amount of damage and assesses the obligation to compensate. The interface to the client must already be working well when the damage is being assessed, since the client no longer sees himself merely as a premium payer, but as a claimant, and expects good service.
Claims managers work closely with underwriters and relationship managers. This cooperation allows insurers to improve their risk assessments and optimize claims prevention.
Manual claims settlement takes time. That is why insurers automate claims processing and assessment as much as possible. The ACTICO Rules insurance software supports claims settlement by automating the following processes:
Checking whether the damage is covered by the premium
Ensuring that there is no insurance fraud
Checking the damage amount and replacement value
Controlling other service provider
Storing directories and rules for reducing bills and automating payment
Automation in claims settlement is achieved with business rules. As soon as a claim is reported, ACTICO Rules come into effect. They make a decision based on insurance premiums and internal requirements. Claims managers, underwriters, and relationship managers can focus on exceptional cases that cannot be decided automatically. ACTICO Rules consists of a graphical interface. This makes decision rules entirely transparent and readable by the specialist department and by IT.
Insurance companies can use their clients’ data to automatically create risk models for underwriting and claims management. Machine learning provides methods that make better risk decisions and complement rule-based models.