Operational management: Re-setting the foundations within claims

It means eliminating traditional boundaries and combining silos in order to anticipate how one change in the insurer’s ecosystem creates a chain reaction across its people, processes and technology.

Historically, the claims function has typically focused on the technical resolution of claims — often to the detriment of staff performance and client experience. But as businesses in every sector have discovered, client experience and related employee performance are critical to success in the digital age. Claims teams are no exception when it comes to putting clients at the center of everything they do, and operational management is central to this.

Claims teams are on the front lines of client service and face difficult conversations as clients expect personalized service that’s convenient, efficient, responsive and flexible. Today’s clients expect greater transparency in the claims process, shorter wait times and new self-serve capabilities to tell them what is happening. Claims teams must be equipped to serve clients effectively, while also being encouraged to identify issues within the claims process that need to be escalated or improved to sustain efficiency, productivity and service.

Claims and operational management leaders should ask themselves if their current approach is enabling an accurate, top-down, fully connected view across the claims ecosystem at any given moment. Insurers need to reliably identify, and anticipate, the number of claims emerging over any given period, the number of people needed to log and manage those claims, and the capabilities, resources and processes required to meet client needs quickly and effectively over the claims lifecycle. Having standard processes and best practices in place to ensure such efficiencies begins with operational management.

Claims teams will feature new skills and modern workplace cultures that continually increase collaboration, streamline processes, optimize services and ensure efficiency. There must be clarity over all standard procedures, with updates and improvements shared consistently.

Creating such a service-based culture requires not only the support, encouragement and upskilling of leaders but also upskilling and cross skilling of claims teams to ensure they possess the capabilities needed to excel in a connected, client-centric, data-based environment. Operational management is crucial to success on this journey.

In our experience, however, insurers are facing roadblocks to modernizing teams and cultures. Sub-functions and claims teams from different lines of business often work in silos that hinder communications and service delivery. A ‘problem-solving, continuous-improvement mentality’ is needed but often missing from today’s typical claims team workflow and culture.

Claims teams will need to be appropriately skilled to manage complex claims within largely automated claims processes, interpreting and analyzing data with the support of the actuarial team and underwriting. The claims function will focus on analyzing client and marketplace data and trends, while performance management and problem solving will be integral and highly structured.

Operational management will need to ensure that in this future environment, the knowledge base underlying claims processing is not only sustained but continually enhanced so that employees are consistently providing timely and reliable expertise.

Embedding new processes through a structured performance-management program, one featuring appropriate coaching, development and feedback mechanisms, will drive consistency and reliance on best practices throughout the claims function. In this way, staff will know what they need to do in order to succeed amid ongoing change. Opening a two-way channel of consistent communication and feedback among teams and leaders is crucial in our view.

Creating a collaborative, service-centric ecosystem is becoming increasingly important as working remotely goes mainstream. Operational management must maintain a clear view and understanding of people and processes as business models evolve and ensure that appropriate skills and capabilities are in place to meet the changing demands and requirements.