Develop the right team
Another element that insurers have within their control is the experience and training of their claims teams. This factor is particularly important as the industry develops more medically and financially complex insurance products.
In the past, many insurers hired recent college graduates for claims processing positions. Inexperienced professionals could handle the administrative aspects of the job, but what about the high-pressure prospect of communicating a denial to an emotional customer? Or explaining the specific terms and conditions of a complex disability income insurance (DII) product?
Ideally, the claims team dealing with complex living benefits like DII or critical illness products should either have a legal or medical background. Allied health professionals like nurses, psychologists, or occupational therapists also have a strong skillset for claims adjudication: medical experience and frontline customer experience.
It takes more work to recruit and train these experienced professionals, but the results are worth the effort. An insurer’s claims team will have the skills needed to talk to customers, explain policies, and understand the ins and outs of complex insurance products.
Make it easy to engage
Excellence in claims service can and should be a strategic focus for all insurers and is particularly important at the point of a denial. Consider focusing on these elements to enhance customer experiences during claim denials:
- Provide user-friendly systems for submitting documentation: Adopt digital processes that allow policyholders to easily submit documentation. People may be caught up in the financial and emotional aftermath of a loss or injury; reduce their mental load by providing clear pathways to submit information.
- Do not delay: If an adverse decision is the likely outcome of a claim, try not to prolong the inevitable with delays or requests for additional evidence. Claims teams should make decisions quickly and confidently.
- If possible, pick up the phone: Many policyholders still receive a denial letter or email that is densely written and runs on for multiple pages – not the best way to receive bad news. Whenever possible, claims professionals should contact policyholders by phone and provide – with respect and empathy – clear information about the adverse decision being made on a claim.
RGA will soon be releasing two new PATHFINDER claims training modules which address the topic of managing difficult claims conversations. These modules share insights, tools and techniques to support claims assessors when managing difficult conversations with customers. The modules are highly interactive and engaging and will be available to RGA clients via the Global Claims Manual / Guide.
Connect claims outcomes to business strategies
Claims teams have valuable insights on how products play out in reality. They know the pain points of contracts, the terms that are confusing, and the type of misrepresentations or non-disclosures that result in denied claims. Wherever possible, develop feedback loops so product development teams can use those insights to make needed changes.
For example, frequent non-disclosure issues could indicate an insurer needs to redesign their forms or consult with behavioral scientists to develop questions that illicit more accurate customer disclosures. Claims teams should also have access to a formal process for sharing concerns about policy wording.
Declined claim analysis can provide helpful data – and not just about how an insurer’s outcomes compare to its competitors. Discovering why claims are denied can lead to impactful changes and improvements in product development and application design. But those outcomes are only possible if claims professionals are empowered and enabled to provide actionable feedback.
It is never easy or enjoyable to deliver bad news to a customer. But the right to manage claims – and make difficult claims decisions – is and always will be central to an insurer’s business. By investing in claims teams, dealing directly and fairly with customers, and tying claims outcomes to overall business strategies, insurers can slowly and surely turn the tide on public perception and achieve our industry’s goal of protecting people when they need it most.