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.