How to Simplify Your Claims Processes to Improve Growth

Posted on

March 9th, 2020


Filing an insurance claim is often a frustrating time for customers as they’ve likely experienced a loss. A claims process that is difficult or slow to produce results can further those aggravations and can cause customers to look elsewhere for their insurance coverage. There are a lot of factors that contribute to customer loyalty, and the claims experience tops that list.

Technology Band-Aids No Longer Bridging the Gap

Customer Pain Points

Insurance providers know that customers expect a mobile application and an online portal to manage their bills, policies, and claims. However, simply developing an app is not enough. Many forms still require customers to download and print them out to complete. Then they have to scan and upload the document.

This process is time-consuming and no longer realistic. The setup of a desktop computer with a separate printer has faded into technology history as more people rely on laptops. The need to print things in general has decreased as more industries get on board with electronic documents and signatures. Add in the cost of buying a printer and ink, and owning a printer becomes costly and unnecessary.

Electronic forms still pose problems for customers as well as many aren’t responsive. If the customer happens to be home and have access to their laptop, they can fill out the form. If they attempt to do so on their phone or tablet, however, many begin to experience compatibility problems. In a high-tech world, these kinds of difficulties are unacceptable to most insured customers.

Insurance Provider Pain Points

Even when insurance providers offer forms, they often lack the ability to capture the information contained within it. This means they have to manually carry over the information the customer provided, which takes time and is prone to human error. Many forms also lack all of the details insurance adjusters need to process the claim so they end up contacting the customer to ask for the information again. This aggravates the customer as it comes across as redundant and delays the claim.

Switching from paper to a truly high-tech digital process can save insurance representatives’ and adjusters’ valuable time processing claims, expedite the claim for the customer, and improve customer satisfaction with the overall claims process. The experts at Actec understand what insurance providers need out of their claims handling processes. Contact us to learn how we can help improve your claims intake, FNOL, and more.

Reducing the Likelihood of Employee Fraud

Posted on

August 6th, 2019


shutterstock_174875483Despite proper planning and safeguards, workplace accidents can happen. Injured employees often file worker’s compensation claims to help them pay for medical expenses and lost wages while they recuperate. However, some unscrupulous employees abuse the system and it costs everyone money. Fraudulent claims increase insurance premiums for employers, the workload for the remaining employees, the time required to complete projects or provide services, and manufacturing costs due to production delays.

Minimize the Prevalence of Fraud

One-hundred percent prevention isn’t always possible. However, employers can take several steps to reduce instances of fraud. These include:

  1. Full screening before hiring. Employers should only consider complete job applications. Missing information can indicate laziness or a history to hide. Employers should also follow up on job references as well as ask their contacts if they know anything about the applicant’s job history. Taking these steps prior to providing a job offer can save employers a lot of time, money, and hassle.
  2. Creating and enforcing safety programs. Employers should hold onboard training as well as continued safety-training exercises throughout the year. Improving safety will reduce accidents and injuries. If employees aren’t getting hurt, they won’t file worker’s compensation claims—fraudulent or otherwise.
  3. Establishing a return-to-work plan. After an employee files a claim for a work-related injury, employers need to follow up on a regular basis. An employer who stays up to date with the employee’s recovery can establish realistic expectations and make the necessary modifications for the individual to return to work.
  4. Not tolerating fraud. Businesses can work with their insurance company to develop methods that best prevent, identify, and rectify incidents of fraud.

Companies can also invest in an absence management system that can flag questionable absences to help employers manage employee attendance. If your company is struggling with employee absenteeism, abuse of paid leave, or fraudulent worker’s compensation claims, Actec can help. Contact us to learn more about our absence reporting system.

What Trends Will Disrupt the Insurance Industry in 2019?

Posted on

January 28th, 2019


Last year, the insurance industry grappled with promises to support innovative technology such as artificial intelligence (AI), machine learning, and cloud services. As 2019 kicks into gear, many within the industry are wondering what to expect in the coming year.

If the past is anything to go by, technological demands will increase, fostering greater competition among insurers. To stay ahead of the curve, industry insiders will need to prepare for the following trends:

  1. Enhanced public scrutiny of artificial intelligence. As the excitement over the capabilities of AI wanes, public scrutiny is expected to increase. The public and regulatory bodies will want to implement controls to ensure AI processes are free of discrimination, are transparent, and, above all, are secure. Insurance providers will bear the brunt of that responsibility.
  2. Smart apps. AI combined with machine learning has allowed insurers to improve the customer experience on their websites and other platforms. For example, insurance providers have experienced great success with chat bots to improve customer service efforts. As a result, many are leaning harder on machine learning for data collection and analysis to find new ways to improve the user experience in real time.
  3. Increased focus on privacy. Several major data breeches consumed headlines in 2018, enhancing the public’s focus on privacy security. As lawmakers look into defining the legalities of online privacy, insurers need to keep an eye on their apps. Many applications rely on location tracking software, a feature that is coming under scrutiny.

Technological advancements aren’t likely to slow down anytime soon. However, insurance providers will need to keep up with consumer demand for innovative technology in claim reporting and other interactions while balancing their privacy concerns. Contact Actec to learn how we can help your insurance company improve claim intake and first notice of loss without compromising data security.

How to Balance FNOL Fraud Prevention with Customer Service

Posted on

January 21st, 2019


When customers file a claim, they want a rapid but fair resolution. Insurance companies that establish high-quality standards of service and consistently adhere to them experience better customer retention than those that don’t. In addition, implementing these standards can reduce the cost of claims as well as the amount of time it takes to process them. While most insurers know this, many struggle with how to achieve this on a regular basis.

This is in large part because of the many balls insurance adjusters have to juggle while handling a claim. They need to balance the risk of fraud against the need to provide excellent customer service. Otherwise, the first notice of loss (FNOL) process can rapidly get out of hand. How the FNOL process goes will color the insured’s opinion of the entire claim and their insurer, but adjusters need to remain vigilant against fraud as well.

Using Data to Improve FNOL and Fraud Detection

To achieve this balance, insurance companies need to gather a plethora of data on a short timeline. This information can provide vital insights into claims to help adjusters determine their next steps. For each instance of FNOL, adjusters need to gather the following information:

  • Policy data: Date, exemptions, renewals, etc.
  • Claim data: Date, time, etc.
  • Loss history: A customer’s claim history can provide important fraud insights
  • Public data: Third parties often provide insights into common claims, which can help insurers establish priorities
  • Extracted data: Insurers can flag claims for further review based on mined information such as an insured waiting several days to report a claim

Insurance providers can expedite many of these processes by implementing artificial intelligence (AI). Machines are able to compare vast amounts of data about claims much faster than humans can, allowing them to flag suspicious claims. Adjusters can then review the claim to determine if it bears further investigation or not.

If your insurance business is struggling with FNOL or the claims process, Actec can help. Contact us to learn how we can help you improve FNOL while streamlining your claim cycle.

5 Warning Signs of Fraudulent Car Insurance Claims

Posted on

October 1st, 2018


Insurance call centers fielding incoming claims need to familiarize themselves with common red flags that indicate fraud. While a call may seem ordinary at first glance, inconsistencies can tell another story. If an insurance representative thinks the claim may be dishonest, he or she can perform some rudimentary background checks. For example, did the customer finance the car? If the customer is upside down on the loan or recently lost his or her job, there is an incentive to get rid of the car.

The following are some of the biggest indicators that an auto claim may be fraudulent:

  1. Hit-and-run accidents. Several incidents of hit-and-run claims are legitimate. The insured can describe the vehicle that hit him or her, and they may even have a partial license plate number. At the very least, they can provide clear details about what happened. However, when an insured customer calls in to report a hit-and-run, but he or she is shaky on the details, the claim warrants further investigating.
  2. Recent or incongruous coverage. Collision insurance is standard for every insured customer. Many choose to include comprehensive as well. However, if an insured has only had collision coverage for the previous decade and suddenly adds on comprehensive, this should trigger a red flag for any claim that follows on its heels. For example, if an insured customer discovers a tree fell on his or her car, the collision would not cover the damage. However, if the damage isn’t severe enough to prohibit driving the vehicle or if the insured can wait it out, they may take out a comprehensive policy to use after the fact. Other times, insured customers will take out policies with way too much coverage for the condition of the car. Any claim that occurs in this situation should also prompt further investigation.
  3. Unusual communication methods. If a client refuses to receive documents by mail, this can be an indicator that the claim is false. The client may not live at the location listed on their policy, hence wanting all documents handled electronically or in person. Insured customers who are hard to get ahold of by phone can also be an indication of fraud as email correspondence allows them time to get their story straight whereas phone calls require them to remember details on the spot.
  4. Repeat offender. Insured individuals who are in similar accidents on a regular basis may require another look. For example, if a customer files hit-and-run claims several times a year, they may be false. There are always plausible explanations, such as if the customer has street parking on a busy road, but it’s worth further exploration all the same.
  5. Charred remains. Many would-be arsonists are under the false impression that burning a car to the ground gets rid of all the evidence. However, today’s forensics and investigators can usually identify the accelerant. If any of the above elements apply (i.e. the vehicle is over-insured, the customer can’t afford the car payments due to life circumstances, etc.), that is all the more reason to investigate a burned car. Another factor to consider is the location. If the vehicle is in an empty area far from any other structures, this can indicate the fire was set on purpose.

Insured customers have several reasons for filing fraudulent claims. With vigilance and keen observation, claims adjusters can pinpoint common signs of a false claim. However, no human is perfect. If an insurance company wants to keep fraudulent claims to a minimum, they will need to put a quality system in place. Contact Actec to learn more about our full cycle claim and incident reporting solution today.

Do You Know the Best Way to Prevent Car Insurance Fraud?

Posted on

February 19th, 2018


impacted carTechnology has forever changed how insurers interact with their customers. However, this is not always to the benefit of both parties. With increased online interactions (i.e. quotes, claim submissions, payments, etc.) came a rise in fraud. While banks and retailers have taken the lion’s share of negative press, the auto insurance industry is just as susceptible to cybercrime and fraud.
However, not all fraud affects the auto insurance industry in the same ways. For example, customers commit soft fraud such as lying about how many miles they drive per year or where they store their car. This affects an insurer’s ability to provide accurate quotes. Digital fraud poses a much bigger risk, as it is more likely to affect an insurer’s bottom line. To make matters worse, according to the Coalition Against Insurance Fraud, fraud is mounting. More than 60% of auto insurers confirmed a dramatic increase in fraudulent cases over the past three years.

Balancing Customer Satisfaction with Fraud Protection

Insurance customers, millennials in particular, want seamless interactions with their insurance provider. They also want a variety of communication methods including emails, texts, websites, and online apps. They also want rapid claims resolution so they can receive their money as soon as possible. While this is exceptional for the customer experience, it leaves significant opportunities for cyber criminals to abuse. Solid digital fraud prevention software can help flag common markers of fraud, but that only goes so far.
The greatest challenge facing insurers dealing with fraud is a lack of IT support. Fraud detection software can trigger several false positives, and not every agency has the workforce to sift through which are legitimate and which are fraudulent. As a result, insurers across the nation are increasing their IT budgets to balance the need for superior customer experiences with fraud detection and prevention.
First Notice of Loss (FNOL) represents the greatest opportunity to identify fraud, but not all agencies are utilizing it to its full potential. Fraud investigators rely on claims triaging to notify them of potentially fraudulent claims. However, without a robust trove of data, many adjusters rely on their instincts to forward on potential fraud cases. Improved technology can revamp the claims triaging process to use current and historical data to identify fraud with greater accuracy. This also helps expedite legitimate claims so customers are not held up waiting for payment because of a false positive.
Fraud is not going to stop anytime soon so insurers need to develop strategies to manage it now. To learn more about identifying and reducing fraud risks, contact the experts at Actec today.

How to Catch Fraud Before You Pay the Claim

Posted on

January 2nd, 2018


aiInsurers catch most instances of fraud after they already paid for the claim. However, it is harder to get money back from a fraudulent claim than it is to prevent fraud in the first place. This was not always the case. With the rise of powerful analytics, insurers can use the data to make predictive models. These models can trigger an investigation into a claim if it contains markers of previous cases of fraud. This will allow insurers to stop fraud before paying the claim.

How Data Models Work

Data analytics are not new, but insurers had not been able to use them to their full potential until now. Statistical modeling and machine learning were not readily available in the past, but the technology has made significant strides in recent years. For example, an insurance agent could always survey claims data and try to draw conclusions. However, this method would prove too slow and too prone to error to be reliable.
With machine learning, the insurance agent presents the machine with sets of data (in this instance, true claims and fraudulent ones). The machine then learns over time how to develop insights into these sets of information. The machine can then use this knowledge and apply it to new claims. Through this method, the machine can interpret with reliable accuracy if a claim is high risk of being fraudulent.

Catching Fraud During FNOL

It is best to identify fraud during or right after first notice of loss (FNOL). This is because each step after FNOL is investigative or communicative. It is easier to look for fraud at the outset of the claim than to go back after the fact and try to find the relevant information.
Internal and external data are both relevant for fraud detection. Internal data, the information insurance agents collect, can provide common fraud statistics. However, external data is just as important for statistical modeling. This includes information such as regional demographics or weather conditions during the time of the loss. All of this data combined creates one premier set of data to use for predictive modeling.
Fraud is not the cost of doing business—at least not anymore. Fraud detection and prevention will always be a crucial element to claims management, but, with new technology, insurers can simplify and expedite the process. They can even identify fraud before they pay the claim. To learn more about claims management and fraud prevention, contact the experts at Actec.

Employee Absence and Fraud Prevention Through Call Center Services

Posted on

November 18th, 2014


Don’t let employee absences slow down your organization. As soon as an employee reports an absence, there are many steps to be taken. Automatic notification of all affected parties, activation of procedures to find a replacement, and beginning the intake process for absences related to short-term disability, long-term disability, or Family Medical Leave Act (FMLA) incidents are all crucial elements. Beyond this, Actec also records when the absence will begin and when the employee will return so you can plan accordingly, all without consuming your supervisors’ valuable time.

It’s equally critical to stay connected with feedback from your employees regarding fraud, theft, sexual harassment, ethical concerns, equipment breakdowns, and safety matters to eliminate potential problems before they evolve into serious liability issues and lawsuits. Proactively soliciting feedback from your employees not only reduces your liability, but it also increases retention and improves the working environment for all of your employees and keeps you in compliance with the Sarbanes-Oxley Act of 2002, which mandates that companies provide a way for employees to submit anonymous reports about financial irregularities without fear of retaliation.

First Notice and Corporate Loss Prevention

Posted on

November 11th, 2014


First notice of loss plays a crucial role in loss prevention for large-scale corporations. This manifests in multiple ways. Accidental misreporting or under-reporting can occur, resulting in lost time for the company. Intentional misrepresentation of time, injuries, and other issues can also occur. Without a system in place to track and verify these incidents, problems like these will arise. Studies have shown that the incidence of theft increases dramatically when the opportunity is evident. Employing a thorough FNOL program shows that a company cares about its employees in multiple ways, including increases to the bottom line.

Absence Management Best Practices

Posted on

October 21st, 2014


Absence management procedures consist of many complexities and intricacies, but every company should know the fundamentals. This begins with timely coordination. Absences must be reported and confirmed promptly in order to optimize turnaround time. The next step is verification. The type of absence, anticipated duration, and other relevant circumstances must be documented thoroughly and accurately. Next, this data must be stored in an appropriate database where those who need to access the data can do so, and those who shouldn’t cannot. Finally resolution – it’s imperative to follow up so as to confirm the extent of the absence, what transpired, and whether or not further action or reporting is required. Within each of these large steps lie a number of smaller steps. For more information, ask us (the experts)!