feature Story BY KarThiK BaLaKriShNaN aND JaNiNE JohNSoN
Manage Claims and Customers with Critical Insights
missed opportunities or poor decisions can significantly affect claims outcomes and business results.
Time management and multitasking
are prerequisites for today’s worker but
the demands on an adjuster are arguably
more pronounced. For most claims, the
adjuster relies on the insured and/or the
claimant to provide information and documentation, which might come in small
increments or all at once. In addition, the
multitude of claims that adjusters manage
simultaneously creates unique workflow
pressures that can lead to incomplete facts
and missed actions.
Following an investigation, for example, an adjuster may conclude that the
loss suffered by an insured was caused
by a hit-and-run driver, and he or she
may therefore intend to find out if the
police have identified a suspect. Because
of the workflow pressures mentioned
earlier, however, that well-intentioned
adjuster may forget to add a “diary” for
this action, and the follow-up may never
actually happen. Similarly, even if the
adjuster discovers that the police have
identified the suspect driver, the adjuster
may miss subrogation on the claim. Finally, in the event the claims adjuster
determines that subrogation exists, he or
she may very well miss sending the case
to the recovery unit because of the workflow pressures.
in today’s challenging global economy, insurers face the difficult task of controlling costs and allocating resources and capital effectively, all in the face of intense, rising competition. Generating additional business lift more efficiently is a high priority, and insurers are increasingly relying on new data sources and advanced analytics
to do so.
Text mining is one such capability that property and casualty (P&C) insurers are increasingly using to uncover critical insights from unstructured data sources. Using text
mining, carriers are able to identify high-impact opportunities selectively, control losses
and costs, allocate resources, and optimize financial outcomes. In the back office, text
mining allows them to gain a better understanding of their claims operations, minimize
missed financial opportunities, optimize workflow, detect potentially fraudulent claims,
and derive actionable insights from customer feedback, among many other benefits.
Enhancing Claims Effectiveness
At the center of the claims-handling process, adjusters have an unenviably difficult
task. They must not only accurately evaluate losses and negotiate fair and equitable settlements but also assess claims for a number of additional routing opportunities, such as
subrogation, fraud, independent medical examinations (IME), and case management.
Claims adjusters’ knowledge, expertise, and attention to detail are crucial because any
Text mining can help alleviate such
oversights by automatically analyzing the
adjuster’s notes and sending alerts about
opportunities for action. As a simple example, a text mining system may recognize
the phrase “hit-and-run driver” and automatically add a diary entry for the adjuster
to “please identify hit-and-run driver.”
Another text mining engine might closely
follow hit-and-run cases and seek to detect the concept of “adverse driver identified” in the ensuing adjuster notes. Once
a detection has been made, the claims adjuster could automatically be prompted to
“please evaluate subrogation opportunity.”
Such text mining alerts can significantly
improve the efficiency of the adjusting process while drastically reducing the number
of missed opportunities for adjuster action.
Although setting up a text mining
system can be challenging given the un-