Claims Management

What is claims management?

Simply put, claims management is the entire process of handling and resolving insured customers’ claims. The management of any given claim starts with the first notice of loss (FNOL), and it can include the disbursement of payments. Although insurance providers rely on claims management to make their business model work, they sometimes outsource this process to companies such as third-party administrators (TPAs) rather than performing it in-house.

One of the central challenges of claims management stems from the twin needs of accuracy and efficiency. Insurance carriers know that the risks of underpaying or overpaying make it especially important to resolve claims fairly, accurately, and reliably. But the administrative costs involved in claims management are also significant, and an inefficient approach to managing claims can cost companies inexpensive work hours (as well as in customer satisfaction and, in extreme cases, even in legal troubles). As a result, insurance companies need to manage claims quickly yet carefully.

The need to maximize both accuracy and efficiency makes digital transformation particularly important for the field of claims management.

How is technology changing claims management?

As automation and cloud technologies have developed over time, they have allowed for data-driven claims management solutions (CMS) to increasingly meet companies’ claims management needs. Whereas these solutions used to be offered only on premises, today’s companies have the option of using a cloud-based CMS for greater flexibility, efficiency, and scalability.

Perhaps most importantly, advances in automation and cloud technologies have created new possibilities for claims management solutions to use machine learning. This approach can allow them to provide just-in-time guidance and other types of data-driven claims intelligence to help claims adjusters maximize both their efficiency and their accuracy.

How is Five Sigma moving the field of claims management forward?

Helping insurance companies make the most of their claims data, Five Sigma’s CMS capitalizes on the potential of machine learning to streamline and enhance claims management. With an intuitive interface reflecting the day-to-day work of managing claims, this solution empowers companies to resolve claims quickly and fairly. By providing valuable guidance and automatically recommending next steps to take, Five Sigma helps even professionals with little experience to perform like their most knowledgeable and successful peers.

In addition to providing useful claims intelligence, Five Sigma’s CMS helps insurance companies optimize the accuracy and efficiency of their claims management by streamlining communication surrounding claims. With an omni-channel communication module built right into the platform, Five Sigma makes it easy to interact with customers and other relevant parties by calling them, emailing them, texting them, or video chatting with them directly through the CMS. This way, all claim-related communications are automatically documented and indexed. And with ready-made message templates for claims adjusters to use, Five Sigma helps make communication more consistent and less time-consuming.

Claims management can have a powerful impact on the profitability of insurance companies, and making it work accurately and efficiently should be a priority for them. While there is nothing new about the importance of claims management, progress in automation and cloud technologies has created new possibilities for even inexperienced professionals to manage claims quickly, methodically, and reliably. By tapping into this potential and taking an intuitive approach to claims management, Five Sigma helps claims adjusters to optimize their performance and contribute to their companies’ overall success.