Claiming the Future

In the next stage of claims automation, insurers are looking to improve information sharing -- with internal claims specialists and external partners and policyholders.

Fraud Fighting

Workflow applications also are playing a role in helping carriers fight fraudulent claims. "Anything carriers can do to better manage the claims process -- whether it is handling, settling, paying the claim or detecting fraud or misuse of insurance products -- provides an ongoing return on investment to insurance companies," points out Brenda Davis, CIO and senior vice president of Sarasota, Fla.-based FCCI Mutual Insurance Holding Co. ($549.14 million in 2005 total revenues).

Some insurance systems providers, including SAS, are augmenting their software platforms with fraud-detection modules. "By integrating business intelligence, OLAP and data integration within insurance industry-specific data models, this architecture enables insurers to use analytics to solve many different business challenges," says the company's West.

ISO also is helping insurance companies fight fraud with its new Special Investigation Unit (SIU) Case Manager tool. Designed to track all steps in the investigation and surveillance of claims documents and submitted photos, "our browser-based SIU gives internal insight into all investigations and touch points that have occurred across the life cycle of the claim," says ISO's Cialdella. "Each month, or annually, companies can also share these insights with the state fraud bureau to keep them abreast of findings."

It's All About the Customer

But regulators aren't the only ones seeking more insight into claims processing. As policyholders increasingly are becoming more tech-savvy -- and time-starved, thanks to hectic lifestyles -- customers are demanding more immediate access to their policies and claims. As a result, many companies are delivering customer-facing solutions that allow policyholders to monitor claims.

"Our culture demands that we have immediate access to information," says Mike Fess, product visionary, ImageRight. The Conyers, Ga.-based company provides a document management and workflow system for the insurance industry. FCCI, for example, uses ImageRight's workflow and document management solutions to streamline its claims operations.

"We don't want to wait in queue on the customer service line, and we don't want to be told to go to the corporate Web site if there is no way to attain the data we want," Fess continues. "Thus, insurers need to allow policyholders to find claims information immediately."

This trend is increasing as the tech-savvy Generation Y (which loosely refers to the customer segment born between 1980 and 1999) becomes a large, lucrative customer base for many insurance products, including car insurance, health insurance, even homeowners and life insurance. "As early adopters of self-service technologies, this group is influencing carriers' move to more-innovative delivery solutions," explains Michael A. Lucarini, New York-based global managing partner, claims practice, financial services, Accenture.

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