Better Decisions = Happier Policyholders and Employees

by Jeremy Jawish

I am sometimes amazed by the sheer number of complex processes and sub-process that drive the insurance industry on a daily basis. And each of these processes are themselves driven by an almost countless number of individual decisions. For a majority of the insurance industry’s existence, these decisions have been made by individuals, using manual and time-consuming methods.

Do they underwrite the policy? If so, how much risk are they willing to assume and how much do they charge the policyholder for taking on that risk? Are there mitigating factors that make a policy for this individual or company more or less risky? And what are those mitigating factors? In the event of a claim, is the claimant an actual policyholder? Does the policy cover the event and if so, for how much? Is there the possibility that a third-party is responsible for all, or part of the claim? Is there evidence that the claim may be fraudulent, or that the policy is being used to commit a crime?

Insurance professionals around the world are making important decisions based on these and so many other questions on a daily basis. And they are doing it for multiple customers on any given day. While it may seem like some — if not all — of these decisions are easy to make, most of us in the industry know it is often not that simple. Let’s take a look at what happens when a customer calls in for what one might consider to be a basic claim. A customer service representative or agent needs to confirm the caller’s identity; pull up their policy; confirm the policy belongs to the policyholder; confirm the policy is in good standing; confirm the policy covers the reported claim; determine if a deductible applies; and the list goes on and on. It can be a time consuming and repetitive process. All of these decisions are important, and need to be made to ensure claims are settled as fairly and accurately as possible. And these same types of questions are being asked at underwriting, when determining if a subrogation opportunity exists, or when determining if potential fraud is occurring.

Some might ask, “but what’s the big deal? Is this even important?” I would argue that it is critically important. These processes are not just operational. They are not only about running the business. They can, and do, have a profound impact on both insurance professionals and their policyholders. For example, the customer may wonder why they are answering the same questions multiple times and yet still seem to be getting nowhere. They experience frustration at the friction in the process. They wonder why they have paid their insurance company thousands of dollars over the course of several years to feel like they are being treated like they simply do not matter. And they may even consider changing carriers once the claim is settled. For the insurance professional, they may feel many of the same things. They know the situation may be unsettling, or even traumatic for the policyholder. They want to be there for their customers. They want to make the process as seamless and easy as possible. They want to settle the claim quickly and fairly. Unfortunately, they may not feel empowered to do so.

Is there a better way for insurers to make these critical decisions? Can they do so in such a way that frees insurance professionals to focus their energies on more complex claims, or those claims where the policyholder may need a little more attention and compassion? The good news is that the insurance industry is accelerating its use of automation across many of the processes that define the policy lifecycle. They are adopting artificial intelligence and other technology approaches to help them make better decisions, and make them faster. And by doing so they are removing many of the hurdles that make it difficult for their employees to feel as if they can truly be there for their customers.

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