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There are enormous differences in the procedures for processing claims related to property and liability and those for granting health insurance benefits. Both processes are demanding and consist of different steps and procedures. The specific processes are very important for the bottom line, as justified claims should be settled quickly and unjustified payouts must be avoided.

Prevention is better than payouts

What both areas have in common, however, is that prevention is always better than payouts. Avoiding damage is always more profitable than settling a claim, no matter how good the claims process is. The focus here is on acting instead of reacting.

Prevention in health insurance

Currently, health insurance companies undertake a number of simple measures to avoid benefit claims. This approach began with paid preventive examinations, for example cancer screening, to detect diseases at an early stage. This was further developed into bonuses for health-conscious behavior, such the bonus booklet that allows patients who book regular dental exams to receive higher payouts if they should ever need a dental implant. Further offers also provide additional assistance to the insured party in special situations. These preventive services are offered to all insurance holders as a rule, regardless of the state of their health or the last time they used the service in question.

We would very much welcome targeted information – that way no one would have to remember their vaccination schedules or routine checkups! Ideally, snail mail would also be eliminated from the process. It would be nice to have a completely digital process for all offers! Change may indeed be imminent.

In the future, the electronic health record (ePA), which has been available since 1 January 2021, will also contain structured data objects, which could form the basis for a more targeted and faster way to distribute offers among insurance holders. Insured parties would receive targeted information about their next check-up appointment. In addition to offers pertaining to the prevention/early detection of diseases, active offers for rehabilitation and therapy can also be made at an early stage. This gives insurance holders the opportunity to return to their normal lives more quickly. Such a system would stand to dramatically increase savings for insurance companies too – not only due to prevention and early treatment of disease, but also thanks to faster rehabilitation and better treatments. The way we see it, it is worth investing in this area and helping to build the system’s potential.

Prevention in composite insurance

The point at which a claim is made serves as a “moment of truth” and has an enormous impact on customer loyalty. The policyholder is only satisfied if processing is fast, transparent and error-free. The risk to insurers is changing as a result of advancing technologisation, and higher claims costs are becoming the rule. Active use of data and sensors can help to prevent claims and keep the combined ratio in line. The insurance industry already has an extensive collection of statistical data at its disposal.

Insurance companies collect large amounts of data when a claim is filed, including the time, location and cause of the claim. Currently, this data is only collected – it is not utilised in any meaningful way. However, if data generated from claims were automatically transferred to suitable service providers inside the partner network, this could reduce turnaround time and thus increase customer satisfaction.

From the perspective of the insurance company, any ideal future scenario would require data to be evaluated, producing new insights about users and their devices. Only then – assuming that users approve of the use of this type of data – can the evaluation of the data help to significantly reduce the incidence of damage and, ideally, help prevent damage from occurring at all.

We would appreciate targeted traffic information, for example, whether or not vehicles ahead have encountered wildlife on a country road. Then the policyholder can adjust their speed accordingly!

How can data be used to actively prevent damage now? Current traffic and congestion information from drivers or traffic authorities is processed to enable other drivers to give a wide berth to any obstacles or hazards. Damage information could also be transmitted to the vehicle in the same way. This data could then be used to avoid hotspots where damage frequently occurs by having the navigation system calculate an alternative route.

Our teams at adesso are not only able to efficiently design claims and service processes in various lines of business; we also use new artificial intelligence (AI) methods to generate personalised offers for policyholders and prevent claims from occurring.

Would you like to learn more about exciting topics from the world of adesso? Then check out our latest blog posts.

Picture Sebastian  Ritzkat

Author Sebastian Ritzkat

Sebastian Ritzkat is a Managing Consultant at adesso and an expert in the areas of claims and fraud management. After graduating and with over ten years of professional experience in various topics in the insurance world, he has already managed numerous projects. As a Lean Six Sigma Black Belt, he was involved in a pilot project at board level. Sebastian Ritzkat is a member of the PMI Germany Chapter and part of the PM peer group at adesso.

Picture Sabine  Fischer

Author Sabine Fischer

Sabine Fischer is Head of the Competence Center HealthServices in the Line of Business Insurance. The CC focuses on digital health offerings for health and life insurance. She has many years of experience in software development and thinks of software from the end user's perspective.

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