Putting customer and employee experience at the heart of a claims revolution

My insurance career began managing living benefit claims, including income protection, total and permanent disability, and critical illness claims. I interacted daily with people going through difficult times. 

That first-hand experience taught me that when someone has to make a claim under their Life & Health insurance policy, it is likely one of the most stressful points in their life. 

For that reason, we have set ourselves the goal of revolutionising the claims experience in Life & Health insurance – and not only for end customers. We also want to improve the experience for the experts managing the claims. 

One way we can do this is by removing or reducing the administration burden and using technology to help us. 

That brings me to the Automated Claims Experience (ACE), a digital claim portal that was born out of an idea at a bootcamp in Asia. This event brought together people from across our business – including client-focused individuals, cross-functional teams and technical experts – to collaborate on developing new ways to improve what we do.

We wanted to modernise the paper claim form process. However, instead of simply making a manual process digital, we saw an opportunity to fundamentally improve the approach in this field by adding a level of personalisation. This would ensure we get the required information up front and reduce the need for further requests.

In the Life & Health claims environment, every little thing you can do to create a transparent and empathetic environment for the customer can be really valued. So, we wanted customers to be able to track their claim status and know where things were up to at any given time throughout the process.

On implementing ACE, our insurance clients can see a change in calls coming in, with less call traffic regarding claim status. This might seem small, but reducing this traffic means experts have more time to focus on other value-add activities for customers, improving the claimant’s experience as well as the employee’s.

Once the claim is registered in ACE, through modern API integrations with the carrier’s claims or policy administration system(s), data is delivered downstream to Swiss Re’s Claims Automated Rules Engine (CARE), where process automation is advanced even further in the form of risk scoring and adjudication guidance.  

CARE is different but shares the same core principles. It was designed for claims experts by claims experts.

A lot of supporting claim information comes from various sources. CARE guides the expert on what information is relevant at certain stages, and prompts what might be needed next, which helps to shape the assessment process. 

In that sense, it is an efficient assistant for claims management, helping to make the process smoother for both the employee, the claims experts, and subsequently the end customer. 

We are seeing insurers really wanting to improve the claims journey and the end-to-end experience. Our cloud-based integration capabilities can assist with the automation element of the claims transformation and our team can help with continued consultancy throughout the process of introducing automation. This helps the client outline to decision-makers the potential investment and improvement that can be achieved. 

Part of the success we have had to date on claims solutions has come from collaboration with our client. Working closely with them, we employed design thinking as we refined the solution, always ensuring that the customer was at the core, and accounting for the employee experience.

Claims tools and solutions such as ACE and CARE would have been invaluable tools when I started working in claims management; they would have guided me to confidently be able to navigate the many aspects of the process.

That is partly why I am so proud of what the team has created; they’ve built solutions we know will help employees and customers overcome much of the administration burden in the claims process. This will allow our experts time to focus on more empathetic engagements with customers, helping them navigate the Life & Health claims process with confidence.