How to optimise the claims settlement process to ensure a return on investment?

If your company is using a so-called legacy system* and considering its modernisation or is in the process of finding the right solution for claims management, this article will help you understand how modern technologies can transform the claims settlement process into a source of growth and cost efficiency.

Modern transformational technologies in claims management

Modern insurance companies face the challenge of using modern technology to revolutionise the claims management process. In order to meet growing demands and effectively manage the increasing number and value of claims payouts, insurance companies need to implement modern technologies to streamline the claims settlement process. The scale of this challenge is illustrated by the latest data on the increase in claims payouts in Poland.

At the same time, in the insurance industry the focus on improving the customer experience remains one of the CIO’s top priorities, driving investment in digital channels, AI-powered systems and automation platforms. Indeed, the quality and manner of customer service have a direct impact on an organisation’s revenue growth, making process optimisation and automation key drivers in achieving operational efficiency.

At the same time, transformational technologies, including artificial intelligence, support other important business objectives, such as improving operating margins and gaining competitive advantages in an increasingly demanding market.

The claims settlement process and improving the customer experience

Customer service in the claims settlement process is a strategic channel of contact between the insurer and the customer. This is the moment when the insurance company has the opportunity to confirm its credibility and deliver on a key promise sealed by the sold policy, i.e. providing support in a difficult situation.

A quick response from the company, clear and comprehensible communication and a reliable claims settlement process build customer trust and loyalty. Negative experiences at this crucial moment can weaken the customer’s relationship with the company and, in the long term, jeopardise its reputation and position in the market. It is often pointed out that one dissatisfied customer can ‘cost’ a company up to 10 potential new customers.

In the age of social media, where negative reviews spread rapidly, the impact of one unfavourable review can resonate widely. As the aforementioned research conducted by Accenture indicates, dissatisfaction with the claims settlement experience is the most important reason why customers choose to switch insurers. Almost a third (30%) of dissatisfied customers reported that they had switched insurers in the past two years, with a further 47% considering doing so.

How can a claims management system be used to build a positive customer experience?

The possibilities offered by claims settlement systems directly impact the customer experience in insurance companies. As recently as 2021, 8 out of 10 claims settlement managers admitted that they were not taking advantage of key market opportunities, such as digital claims reporting, automated policy verification and automated claims payouts².

Although the technological environment and business conditions have changed since then, many insurance companies still face the challenge of implementing tools that enable, among other things:

• automated document verification and claims assessment;
• reporting claims via mobile apps, online portals or other digital channels by customers;
• proactive communication with the customer;
• using AI to analyse and classify claims reports;
• using automated mechanisms for policy coverage verification and claims payouts.

But can all these goals be achieved if the insurance company has a core system and no plans to replace it? For companies using legacy systems, the priority should be to implement innovative solutions that increase efficiency and enhance the quality of service, without requiring a complete upgrade of the infrastructure. The integration of modern technologies into existing systems allows for a gradual extension of their functionality and improved user experience.

For organisations that are still searching for a claims management system, it is crucial to choose one that delivers value from day one – to the company, employees and customers alike. In such cases, attention should be paid to flexibility, the ability to be easily configured and the system’s ability to scale as the organisation grows.

In the following section, we will present solutions based on Altkom Software’s claims management system, which consists of ready-to-implement components. As a result, it can provide a comprehensive claims processing base for new insurance companies or extend the functionality of older systems used in mature organisations.

How does the AIS Claim Centre build a positive customer experience?

When developing our claims management system, we focused on several important aspects that directly impact the quality of customer service, operational efficiency and building trust in the insurer. Here are the key priorities that guided us during the design process:

SLA monitoring – continuous performance monitoring

AIS Claim Centre enables the ongoing monitoring of key claims processing performance indicators through SLA (Service Level Agreement) management tools. Insurers (claims adjusters) can respond quickly to potential delays, ensuring timely claims processing for customers. Continuous monitoring of the process execution improves service and builds trust.

Multi-channel approach. The system integrates a variety of channels, such as email, SMS, as well as bulk document mailing services, allowing insurers to customise the contact method to customer preferences. It then automatically sends notifications such as “Your claim status has been updated” or “We have issued a decision on your case”. A proactive approach reduces the need for customer contact, building a sense of transparency and efficiency.

For customers in regions with specific communication preferences (e.g. the Middle East), the system can integrate with channels such as WhatsApp, further enhancing accessibility and convenience. This allows insurers to better customise the service to cultural or regional requirements, which provides great value in a global environment.

Decision-making support

The AIS Claim Centre automates key decision-making stages, minimising the time required for verification, approval and claims payout. The automation is fully configurable – it is the insurance company that decides which requests (e.g. requests up to a certain claim amount) should be processed automatically, customising the system to its individual needs and operational policies.

Furthermore, automatically processed claims can be subjected to random verification. This approach optimises processes and generates savings for the organisation.

Claims segmentation and classification

The AIS Claim Centre uses advanced tools to automatically classify and prioritise claims. As a result, more complex cases are immediately directed to the relevant specialists and minor claims can be processed more quickly and fully automatically. Some of the manual work is transferred to digital processes, reducing the workload and allowing employees to focus on tasks that require special attention. This claims portfolio management model enables efficient allocation of resources and reduced processing time.

The claims settlement process and cost optimisation

As already mentioned, the claims settlement process is one of the most expensive aspects of insurance companies’ operations, especially in the context of increasing customer expectations. Properly executed optimisation in this area allows operating costs to be reduced, improve resource allocation and increases the efficiency of the entire organisation.

The aforementioned Accenture report Why AI in Insurance Claims and Underwriting? Improving the insurance experience, indicates that insurers are struggling with ageing systems and inefficient processes. The study found that up to 40% of their time is spent on non-core activities and administrative tasks, resulting in an annual efficiency loss of between $17 billion and $32 billion.

Additionally, more than half (60%) of the surveyed insurers believe that the quality of the processes and tools used in their organisations can be improved.

How does the AIS Claim Centre optimise the insurance company costs?

When developing the AIS Claim Centre, we paid particular attention to aspects that maximise operational savings and optimise teams’ performance. The priority was the automation of repetitive tasks as well as ensuring configuration flexibility and the ability to implement changes quickly through low-code/no-code technology.

Team performance optimisation

Automation of repetitive tasks, such as document verification or sending notifications to customers, allows claims adjusters to focus on key aspects of the claims settlement process. Teams can manage their time more effectively and the most important cases are handled with greater attention and precision. Furthermore, automation minimises the risk of errors resulting from manual operations, improving the flow of the process.

The system supports the claims adjuster in handling high priority cases in the face of the required deadlines, including statutory ones.

Personalisation of communication through a simple template system

The AIS Claim Centre features an intuitive template system that facilitates quick creation and customisation of customer-facing content. This enables easy creation of personalised messages that respond to customer needs and are in line with company guidelines. The flexibility of the solution allows it to respond efficiently to different situations, while reducing the time spent on creating customer communication.

Team performance management

The system supports the day-to-day organisation of the team workflows, including the management of tasks, holidays and replacements. This ensures process continuity even in the absence of key employees. The AIS Claim Centre provides a clear view of the claim adjusters’ workload and availability within the team, enabling better allocation of tasks and preventing delays in claims processing.

Fast implementation of changes and product parametrisation

One of the biggest advantages of the AIS Claim Centre is the ability to flexibly configure claims settlement parameters using low-code/no-code technology. Once configured, the parameters for a particular claim category can easily be applied to new products or form the basis for a new claim category. This approach significantly reduces the time and cost of bringing new products to market.

• Reducing implementation costs: There is no need to involve additional developers or external suppliers.
• Accelerating time-to-market: Making changes to the claim categories or product configurations is quick and intuitive, enabling insurance companies to respond dynamically to changing market and customer needs.

Claims settlement process and insurance company profitability growth

The claims settlement process does not have to be just an operational obligation – when properly managed and optimised, it can become a strategic tool to support the growth of an insurance company. The key is to combine operational efficiency, customer satisfaction and innovative approaches, which together can drive company growth.

The second edition of the report “Digitisation of the Insurance Sector in Poland” shows that digitisation strategies in the insurance sector now cover all areas of companies’ operations – from internal operations to customer service, sales and marketing.

Research shows that in the past two years, up to 80% of insurers have increased their financial investment in technology development and 60% have expanded their collaboration with technology companies.

Additionally, more than 90% of insurance companies are actively modernising their IT systems, replacing outdated legacy solutions with modern technology. Such a perspective paves the way for the implementation of innovative tools that not only improve the operation of companies but also create new growth opportunities and increase their market competitiveness.

How does the AIS Claim Centre impact on insurance company profitability growth?

The AIS Claim Centre is designed to support claims settlement processes in an efficient and scalable way, while enabling insurance companies to achieve better financial results and long-term growth.

Readiness to operate across business lines

The AIS Claim Centre is a ready-made solution that can be implemented for claims handling across various business lines such as automotive, property and health insurance, without the need for time-consuming customisation.

This approach significantly reduces costs and implementation time, enabling the company to quickly enter new markets or insurance sectors.

Versatility and flexibility

The system is designed as a versatile tool capable of handling multiple business lines and supporting different companies within a single capital group.

It enables the integration of different entities, centralising data and processes, which increases operational efficiency by optimising operations and reducing the costs associated with maintaining multiple separate systems.

Cost effectiveness

AIS Claim Centre offers a simple and transparent licensing model that eliminates hidden costs and allows companies to better control operational expenditure. Reducing technology-related costs frees up resources that can be invested in developing new products or expanding into new markets.

Operational autonomy and no vendor-lock

The AIS Claim Centre minimises the risk of vendor dependency through an open maintenance and development model. Key system advantages include:

• Independent customisation: access to the code enables companies to adapt system functionalities independently without the need to involve external suppliers.
• Full maintenance control: organisations can fully manage system maintenance, reducing support costs and increasing operational flexibility.
• No renewable licences: eliminating cyclical licensing fees minimises fixed costs and ensures long-term savings.
• Development flexibility: the ability to actively participate in the development of the system allows customers to customise it to their unique operational and strategic requirements.

What role does AI play in the claims settlement process?

The benefits of implementing AI at various stages of the claims settlement process cannot be overlooked. One of the key advantages is to increase employee efficiency and tasks optimisation. Technology is constantly evolving and its smart application in daily operations can bring tangible benefits across the entire organisation.
The implementation of AI is also an opportunity to build competitive advantage, especially by improving the quality of customer service. Customer satisfaction, especially in the context of claims settlement, is of real importance, making it essential to leverage the expertise and creativity of specialists to optimise processes or specific elements of them.

Learn more in the article: AI in insurance – a catalyst for technological progress?

Summary

AIS Claim Centre is an advanced claims management system that supports insurers in optimising their claims settlement processes. By monitoring SLA metrics and automating repetitive tasks, the system speeds up claims processing, improves service quality and reduces the workload of employees, allowing them to focus on more complex cases.

Multi-channel communication, claims segmentation and the ability to personalise content improve customer service, increasing customer satisfaction. The system stands out for its flexibility enabled by low-code/no-code technology, which allows changes to be made quickly, reducing costs and implementation time.

The versatility and scalability of the AIS Claim Centre make it applicable across various different business lines, while the open operating model ensures full control of the system, eliminating vendor dependency. This tool provides insurance companies with cost savings, increased efficiency and the opportunity for dynamic growth.

Sources:

¹ Accenture, Why AI in Insurance Claims and Underwriting? Improving the insurance experience

² Strategy&, Digital claims transformation, 2021

³  PIU, Accenture, Digitalization of the Insurance Sector in Poland, 2nd edition of the report, 2024