Claim Process Design

Think systems rather than just training

Property claims can be extremely intricate, with countless potential causes of loss. The adjuster’s personal expertise plays a crucial role in comprehending the reason behind a loss and achieving success in claim handling. Their knowledge can significantly influence the promptness and precision of coverage assessment, claim reimbursement, satisfaction of policyholders, expenses incurred from vendors, and overall efficiency.

Even though training employees can be helpful, we think that the most effective long-term improvements involve the creation of proccesses and systems that assist employees. We work with our clients to create and put into action systems that address the most significant technical gaps. Our approach is to construct systems that reduce the adjuster’s reliance on technical expertise, past experience, and struggle with technical uncertainty.

Our Approach

Although there are similarities in the gaps of knowledge across insurance carriers, the effects of these gaps differ depending on the systems and redundencies already in place. Usually, only a few issues are responsible for the majority of the leakage, so it’s practical to tackle those first. Mitigateway begins by analyzing past claims to determine which loss scenarios are the most expensive in terms of leakage and other critical metrics.

In parallel, we complement our client understanding by interviewing different functional groups. This allows to better understand the written and unwritten rules, as well the, sometimes, conflicting pressures that employees face while conducting their job functions.

Once we map out this list of issues, we design solutions in line with our client’s stated goals and resource commitments. Most importantly, we are ready to accompany our clients throughout their implementation.

Mitigateway can help you improve claims handling by designing various elements of its process:

  1. -Solving for front line adjusters’ knowledge gap with technical contextual rules and checklists
  2. -Dynamic and streamlined recovery/coverage investigation playbooks
  3. -Evidence collection protocols
  4. -Segmentation based on technical context of claim (at FNOL or afterwards)
  5. -Playbook of responses to common technical defense arguments (subrogation)
  6. -Recovery vendor management tools & protocols based on technical context of claim