Claims Management Automation is essential to ensuring a good relationship between the company and its customers. Discover the benefits and learn how to do it!

Organizations must have claims management policies to manage customer reviews. Defining your own strategy for receiving, classifying, and distributing customer contacts, in particular complaints, among the various departments or employees indicated is crucial. Automation is the best way to avoid errors and speed up longer processes with rigor and quality.

It is essential that this strategy ensure a quick response to any and all complaints, no matter how insignificant they may seem. The lack of delay or inaccuracy in responding to a simple matter can have negative and even uncontrollable consequences for the business, turning into a giant snowball that can cause misunderstandings and, ultimately, jeopardize the company’s reputation. If the complaint reaches social media, it could harm a company’s years of work.

So that nothing fails, it is essential to automate claims management processes, making them part of continuous customer relationship processes. Gartner points out that new digital business models will have a dramatic impact on business processes. “CIOs face a future in which complaints management will intersect with ongoing customer engagement processes and will no longer exist in its current form," says Gartner.

Meanwhile, the acceleration of digital transformation, boosted by the COVID-19 pandemic, continues to be an opportunity, and if your company has not already done so, you should automate your claims processing management workflows, points out an article from Forbes. Without this automation, the organization faces unnecessary risks of customer dissatisfaction.

The challenges of automating claims management processes

The automation of claims management workflows has become more complex. Customers communicate with organizations through multiple channels (telephone, email, forms, physical and digital complaint books, etc.) and want to be treated in an integrated way. Above all, they do not want to have to explain the reason for their claim over and over again. If you start by telephone, an email message should continue the process, and if the customer accesses the complaints platform on the organization’s website, they should find all the necessary information there. A continuous and complete experience.

From a technological point of view, the introduction of Artificial Intelligence (AI) and related technologies is another challenge for organizations. Integration is essential to prevent software maintenance routines and monitoring protocols from becoming more complex. It is essential to change what needs to be changed through good change management. However, if organizations prefer to continue using old applications, integration with the most recent technologies is essential, ensuring coexistence between several generations of technology.

Furthermore, managers must take into account regulatory and legislative matters as well as threats in cyberspace, in addition to keeping up with the speed of technological changes and political and economic growth uncertainties.

Finally, many companies today deal with an immense amount of data (big data) that must be worked on to enable decision-making based on this data, with the aim of adapting products and services to the continually changing needs of consumers.

The integration of these processes is a major challenge, not only because it is necessary to orchestrate multiple information systems but also because data is stored in physical formats.

The solution is to automate data processing routines. It’s complex, but it’s worth it because the data available at the company is certainly useful for making solid analyses and meeting consumer expectations.

The importance of automating claims management processes

Automating processes is always an added value. People are free to perform tasks with more value, for which human intervention is essential. In the case of claims management, as it is a sensitive matter, this automation is even more important.

As with any change, the secret to success is planning, taking into account that you will face operational challenges to process forms automatically.

  • Creation of consistent forms, regardless of the input channel;
  • Elimination of inefficiencies resulting from the need to manually reintroduce data;
  • Elimination of the need for manual verification of data from different applications;
  • Reduced likelihood of human error.

Key components of claims management transformation

There is no magic formula for transforming and automating claims management. Each company is unique. However, organizations must look for personalized solutions based on their lines of business and business segmentation.

By opting to automate UnikSystem’s claims management process, you are taking advantage of the supplier’s accumulated experience not only in automating processes but also in contact with different sectors of activity.

According to a Deloitte study on claims management in the insurance sector, which, in general, applies to other sectors of activity, these are some of the components that companies should take into account:

Technology can improve claims management based on facts, create a data-driven feedback loop, and improve response time and results.

Interacting with customers through the channel in which they feel most comfortable Opting for digital platforms allows for better cost-effectiveness in the long term. However, not all customers want to use virtual channels. The claims management system must be hybrid.

Management of the transformation journey sensitively. There will always be reluctant employees, afraid of losing their jobs due to automation. Clear communication is essential, explaining to employees that they will dedicate themselves to value-added tasks. Good leadership and cooperation between teams facilitate the transition.

Change planning. Develop a comprehensive strategy incorporating new technologies and data sources without neglecting the human connection with customers.

Furthermore, this strategy must be interconnected with recruitment and training efforts so that companies can acquire and/or develop the necessary skills. In the future, it is not technology that will take away jobs from professionals, but other professionals who know how to use new technologies.

Keep the human-in-the-loop

Automating claims management does not mean eliminating the human element from the process. There are tasks that can and should be automated by taking advantage of technologies such as AI, mobile applications, and much more. But you need to keep Human-in-the-loop to solve unexpected problems and make decisions.

Data sources and technological infrastructure allow the process to be accelerated with more rigor, efficiency, productivity, and reduced costs.

Combining technology with personalized contact with customers, an excellent consumer experience is guaranteed.

In a document that analyzes claims management in the insurance sector, Deloitte details the importance of the personal touch on top of automated processes at a time when claims openings are increasing substantially.

The big challenge is to effectively integrate technology and people to provide the right service at the right price to the right customer at the right time to meet customer expectations.

Advanced technologies and new data sources complement and help customer relationship managers, but do not replace them. They free us from intensive tasks with low added value, providing them with tools to solve each case. Ultimately, customer satisfaction is increasing.

Automating claims management processes cannot mean the absence of interaction between people in natural language. This is an essential element of the experience, especially if problems arise. When the consumer experience is positive, customers are satisfied. If, on the contrary, it goes wrong, the message will quickly spread. And even if it is the exception, a dissatisfied consumer can affect your company’s reputation. Deloitte says it takes approximately 40 positive consumer experiences to undo the damage caused by a single negative experience.

The future of claims management automation

Meeting changing consumer needs in an increasingly technology-centric world is key to creating organizations that adapt quickly in response to constant change and uncertainty.

Currently, the consumer experience ends up being more important than the good or service sold. Although it is essential to ensure more traditional communication channels such as telephone or in-person service for certain consumer profiles, the time has come to cater to a new generation of workers, the millennials, and new purchasing patterns and consumer expectations. This change in behavior is not unrelated to the acceleration of the ongoing digital transformation of many organizations since the years of the COVID-19 pandemic. The disruption caused by the pandemic has significantly altered AI adoption timetables, accelerating digitalization.

From one day to the next, organizations had to adjust to remote work, increase distribution capabilities in customer support, and increase digital channels, explains Mckinsey. Although many companies have not immediately invested in AI, the evolution of digital technologies and the desire to change may now be an opportunity.

Five steps on the journey of automating claims management

Like any other process, Claims Management Automation must be defined, designed, implemented, and constantly reevaluated. Take note:

  • Define the status of the claims management process and where it is intended to go;
  • Design the path for creating the claims management strategy;
  • Find the ideal partners;
  • Carry out pilot projects and fail quickly;
  • Constantly reevaluate.

Low-code business process automation solutions, such as those from UnikSystem, allow this flexibility in implementation..

The impact of Artificial Intelligence on the future of claims management

As an example, McKinsey predicts that by 2030, more than half of complaints will be resolved by automation. The data relates to the insurance sector but can easily be extrapolated. Advanced algorithms will resolve and route initial requests, increasing efficiency and accuracy.

Customer service applications will handle simple interactions through text and voice, following self-learned scripts. Situations will be resolved in minutes, not days.

Complaints managers will focus on unusual or complex complaints and will also be called upon to act when human interaction and negotiation are required, supported by data-driven and analytical insights. They will also be attentive to potential security risks (for example, hackers infiltrating critical systems) and manually review complaints to ensure that the algorithm is working and providing coherent responses.

Subcontracting claims management: an option

Claims management can also be outsourced. Outsourcing helps businesses grow and work more efficiently. In the future, the outsourcing of business processes, or Business Process Outsourcing (BPO), will combine offshore work with Robotic Process Automation (RPA) and AI, according to Nick Tubis, founder of Stealth Scaling, in an article in Forbes. But it is essential to ensure quality control and other tasks performed by humans.

The Stealth Scaling administrator estimates that the combination of automation with human labor could automate between 40 and 100% of the processes carried out by traditional BPOs, contributing to better quality control. When combining work subcontracting with RPA and AI, the benefits are many:

  • Reduction of labor costs;
  • Minimizing the risk of errors and inefficiencies associated with traditional outsourcing;
  • Improved quality control. The human component ensures that machines are making the correct decisions, dealing with exceptions;
  • Greater rigor.

Complaints management is one of the processes that can most benefit from process automation with human intervention by increasing efficiency while maintaining quality control.

How to implement business process automation integrated with human work, according to Nick Tubis:

  1. Identify the processes to automate and which ones require human intervention;
  2. Define the roles and responsibilities of workers and machines in the process;
  3. Train employees to work with RPA and AI or use a BPO partner;
  4. Build an information feedback loop between employees and machines to ensure that automated processes are working properly and that employees are making the correct decisions;
  5. Monitor performance regularly to identify problems as early as possible through corrective actions;
  6. Continuously improve through data analysis and adjustments to optimize performance and increase efficiency;
  7. Keep systems updated.

Claims management solutions are applications that support the end-to-end workflow of claims, from introduction to resolution. Its components include workflows, business process management (BPM) capabilities, rules engines, collaboration and integration tools, process flow models, and good practices from other companies in the sector.

Solution for claims management automatiion

A claims automation solution, like UnikSystem’s, allows the analysis and classification of all claims using Artificial Intelligence and Machine Learning, with unprecedented gains. To know:

  • Data collection across all digital channels;
  • Form recognition and classification to start processing;
  • Automatic data extraction and validation through pre-defined business rules;
  • Error detection and notification of agents to resolve them;
  • Automatic export of data to company systems.

By combining AI technologies with business rules and workflows, it is possible:

  • Automate the entire claims management process;
  • Save costs;
  • Reduce time in the form processing cycle;
  • Increase productivity;
  • Meet compliance requirements;
  • Simplify the digital transition in organizations.

With the support of the Low-Code BPM UnikSystem platform, the need for projects that last for months is also eliminated.

How do we automate claims management?

UnikSystem’s Complaint Management Automation solution is an option to speed up this process in your company using Artificial Intelligence and Machine Learning.

As explained in this article, the channels for filing complaints with companies are increasingly varied. In addition to traditional mail and the physical complaints book, customers complain through call centers, in the electronic complaints book, by email, or through electronic forms accessed on different devices (computer, tablet, smartphone). It is essential to provide a quick and coherent response to the customer, regardless of the channel used. And, most importantly, continue the order regardless of the channel used.

Anyone who submits a complaint in the physical complaints book either follows the process via a telephone call or adds details electronically. Everything has to be properly orchestrated.

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by Ricardo Barros – Chief Customer Success Officer @Uniksystem