Claims Processing and Management: Optimizing the Complex Commercial Insurance Purchasing

David Mathes, Vice President, Underwriting Systems & Training, Ryan Specialty Group

Trends and Challenges in the Claims Processing and Management Space

In terms of trends, I see key adjudication methodologies that were more or less ideational years back, now, bearing fruit. Two key areas where I have seen this manifest are in parametric claim payments and the use of AI in fraud detection.

Parametric claim payment is one of the more fascinating trends I have recently observed in claims processing and management. Under this workflow, claim payments are automatically triggered in the event of a covered loss. This is an emerging concept in lines such as earthquake and cyber products. It is not an entirely new concept, but we are seeing the concept being realized today far more materially than in the past. The best example of this is the earthquake driven parametric claim process. Should an earthquake occur in a covered territory, the insurer automatically notifies all covered insured that they are aware of the incident and are promptly paying the agreed-upon amount to each insured. Automated payments follow shortly thereafter.

Use of AI in fraud detection: More and more companies are now easily able to employ AI software and models to data-mine internal and external data sources to detect certainly questionable and potentially fraudulent claim activity.

Continued challenges in the claims management space are the needs of insurers to respond to regularly occurring regulatory changes across different states and countries. Practices that are considered reasonable and acceptable in one jurisdiction may be utterly unacceptable and even considered unfair claims practices in another. Additionally, certain state governments are liable to enact swift legislation in response to catastrophic events that compel materially increased levels of labor on claims handlers. Examples of these kinds of increased demands include: compressed resolution/ payment timelines, increased reporting requirements to state regulatory agencies, and increasingly high penalties if new restrictive regulations are not promptly adopted and followed.

RSG is continuously looking to optimize the complex commercial insurance purchasing transaction, and a series of efforts are underway to find more effective ways to reach complex markets

Given current events regarding COVID-19, I have every expectation that, in certain states, new rules and regulations will be handed down. While any changes in this space are likely appropriate and aimed to protect the covered insured population, a key difference related to COVID-19 is that all sectors of life are impacted, including the claims adjusters and managers who are tasked with responding while already under duress of their own.

Impactful project/initiatives in the Claims Processing and Management Sector

Presently, my department is working on some very interesting endeavors related to revenue sharing across multiple independent operating units. RSG is continuously looking to optimize the complex commercial insurance purchasing transaction, and a series of efforts are underway to find more effective ways to reach complex markets. I’m fortunate to be leading or contributing to work in two of these.

Strategic Points on Leadership

As a leadership group, we focus on geopolitical concerns such as Brexit, and what the technological/financial/accounting implications will be. Obviously at this point, we are also discussing the impacts of COVID-19 and what that means for our industry and business, both in the long and short term.

Evolution of the Claims Processing and Management Arena

There has been continued evolution of expert evaluation systems and investigative methods, such as usage of drones to survey pre and post-loss properties, Expert systems, much like parametric claim payments and AI, were originally not necessarily delivering expected value when they were initially visualized. As years have passed, these tools have developed materially, and now deliver value in a scalable fashion.

Advice to a Fellow or Aspiring Professional in the Field

BE PRESENT, with a great attitude and a drive to do better than the day before. That’s technically three pieces of advice. The below list regularly appears in LinkedIn feeds and other sources of self-improvement information. I cannot stress enough the importance of the ten things that require zero Talent

• Being On Time
• Work Ethic
• Effort
• Body Language
• Energy
• Attitude
• Passion
• Being Coachable

The above ten items all coalesce into this concept: BE PRESENT. I do not care how smart you are, how funny you are (if funnier than I, jealously ensues regardless), or how well connected you are, within the company or industry. If you cannot be present in your role, you will not thrive, and you most certainly will not advance in your career. At best, you will succeed to a point, but failure to be present always catches up with you.