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Claims handling is one of the most complex issues for insurance companies. It involves activities such as opening and closing claims, making payments, reserving claims, carrying out subrogation recoveries, and working with service providers.
Insurance claims are also susceptible to fraudulent activity. As a result, the information required to combat insurance fraud is an important part of insurance business intelligence.
InsFocus BI’s claims handling solutions are detailed below.
CONTENT INCLUDES:
This involves measuring activities such as the opening, closing, and re-opening of claims, claim payments, and outstanding claim reserves. Measurements of such activity should be conducted separately by claim type on a daily basis. InsFocus BI applies different calculation methods for claim measurements depending on the time perspective (e.g. incurred claims on accounting basis = claims paid+∆ outstanding, whereas incurred claims on accident basis = claims paid+outstanding).
This involves individual analysis for claim indemnity payments, claim expense payments, deductibles set off from claim payments, separately collected deductibles, and subrogation collections. These functions are required for monitoring and measuring the effectiveness of claim department activities. The system provides the infrastructure needed to separate claim elements and perform the required analysis.
Claims activity involves a large number of external entities. Service providers include those entities that provide claim services to the company such as medical centers and clinics, auto repair shops, lawyers, and claim adjusters. Claim parties include those entities with which the company maintains regular claims activity such as other insurance companies, port authorities and social benefits institutions. InsFocus BI provides reporting tools enabling the follow-up of payments and claims activity between the insurance company and its external entities, as well as their effective control.
Claim reserving is an important part of financial management. Measuring the run-off of ultimate claim costs compared to reserves is an essential reporting tool for insurance companies. Using flexible claim status filters, InsFocus BI enables precise measurements of claims run-off, which helps the company improve future reserving.
Fraud detection is an important part of an insurance company’s activity. One way to detect suspicious claims is by analyzing claims activity and highlighting exceptions. The system contains built-in tools and measurements to facilitate fraud detection.