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Why claims adjusters should never handle low-complexity claims

  • Tim Thomas

    Claims Practice Leader, Insurance

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Fast track. Low touch. Minor complexity. Express claims. One and done. Just a few of the names given to the line of claims that are minor in nature and require little adjudication to close. Although these claims are typically low dollar with straightforward liability and coverage, these little gems can become a thorn in loss adjusters' sides if placed in the general population of claims. Their low severity means they get lost in the shuffle, and a claim that should have been closed quickly drags on, leading to lower customer satisfaction, increased indemnity dollars, and even attorney involvement. There is a clear solution, however: use digital technologies to handle these claims.

All these examples illustrate why in the future, from a digital standpoint, adjusters should never handle low-complexity claims.

  • Self-reporting and adjudication: While self-reporting a claim is not new, it should be the catalyst to early identification of low-complexity claims and begin the auto-adjudication process. With artificial intelligence (AI) and machine learning built into the self-reporting process, the first notice of loss (FNOL) engine can recognize and target the correct claims to be expedited through automation. The insurer can also use a chatbot in the reporting process to guide customers through the claim and advise them of next steps, easing them into self-adjudication
  • Inspections and estimates: During an enhanced FNOL process, the customer can self-inspect the damage via a photo app, receiving a link to take and submit photos of the damage using their smartphones. They are guided through the process to ensure all necessary photos are taken in the right order. Once the customer completes the self-inspection, photos are submitted, and using a computer vision estimate platform, the estimate is completed automatically
  • Automatic payment and claim closure: Once the damage estimate is complete, robotic process automation can process the payment, create the necessary documents to send to the customer, update notes and data fields with the system, and final close the claim. With the use of electronic funds transfer or an automated clearing houses, payment is immediately posted into the customer's account
  • Customer satisfaction: The end goal of the claims process is to correctly indemnify the customer as quickly as possible. All the technologies talked about here process low-complexity claims quickly and accurately, drastically reducing claim cycle time to hours instead of days (sometimes within moments of receiving damage photos). Naturally, this speed and accuracy improves the customer's overall experience and satisfaction, which in turns leads to loyalty and retention

But it's not just customer satisfaction that enjoys a boost. Embracing these technologies creates operational efficiencies and cuts costs. Freeing adjusters from handling these types of claims allows them to focus their expertise on more severe and complex losses. Having the right adjudication skills on these bigger losses means more accurate handling, a reduction in cycle time, and increased customer satisfaction on the claims that really impact the bottom line.

The evolution of technology, ease of integration, and increased automation across the claims value chain for low-complexity claims handling means the timing has never been better to take processes from Flintstones to Jetsons and reap the benefits of transformation.

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