With challenging markets, claims and underwriting functions have become a critical focus area for insurers. In our view, successful insurers are looking to:

• deliver proven customer-centric services that are in line with legislative and regulatory requirements
• ensure claims and underwriting operating model effectiveness, while driving innovative uplift with digital and AI technology
• have effective risk management frameworks that maximise the protective value of underwriting, minimise avoidable claims leakage, reduce volatility of the claims experience and create a sustainable and profitable operating model
• identify opportunities for change for improved results and sustainability of the insurance industry.

KPMG offers a leading Insurance Claims, Underwriting & Workplace Health service with specialists that fundamentally change the risk and regulatory scope, and the design thinking applied to the customer being at the centre of the claims experience. We achieve this through access to global solutions and knowledge, and forming trusted relationships with our clients that shape their services and operations for the long term.

How we can help
Our extensive and deep industry experience covers direct insurers, intermediary service providers and reinsurers. Our specialist knowledge and expertise can support:

Managing claims – Providing direct case management services for specific claim portfolios including:

• management of complex and sensitive claim portfolios
• specialisations and expert capability in psychological injury/mental health claims
• injury management, wellness and occupational rehabilitation services
• design and implementation of prevention services – mentally healthy workplaces
• capability resources for poor performing portfolios.
  

Service innovation – Design and implementation of claims & underwriting operating models including:

• customer experience, approach and delivery
• automation and digital claims triaging & segmentation rule sets
• integration of practice & operating models
• simplicity and optimisation of functional service processes
• predictive data analytics and reporting for risk management.

Enterprise risk management – Developing risk and compliance frameworks:

• structures, oversight and reporting
• regulatory and legislative responsibilities reviews
• claims and underwriting risk appetite statements
• development of claims or underwriting principles, guidelines and standards
• monitoring and reporting development – build and design.

Establishing leading industry practice – Including:

• practice standards and conduct analysis (claims and underwriting)
• industry benchmarking of claims and underwriting capabilities as well as experience analysis
• development of tactical and strategic roadmaps for operational improvement
• compliance, conduct and culture reviews against better practice and codes of practice.

People and capability – Delivering:

• quality assurance and competency delegation frameworks
• capability and professional standards frameworks
• training and development programs (case management, mental health claims)
• Key Performance Indicators for professional development against legislations, regulatory standards and internal quality measures.