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Claims

Transforming claims to unlock digital benefits

Our new digital claims solution for open market and delegated authority will be delivered from 2022 through to 2024, transforming how claims are managed in the market. This will allow digital interaction with brokers and insurers with enhanced functionality, reducing the central processing time for claims. There will also be greater transparency for customers and experts with faster agreement and settlement.

Introducing Faster Claims Payment for delegated authority business

This new funding and payment solution will provide fast and direct payment of a claim to the customer; it allows Delegated Claims Administrators (DCAs) to make payments on request, drawing on managing agent funds directly and is supported by a re-engineered claims process enabling greater control and transparency in accounting entries.

The Faster Claims Payment (FCP) pilot successfully delivered 4,450 payments totalling over $16.6 million and more than 20 fully automated replenishment cycles between July 2021 and April 2022, removing the dependency on the loss funds involved. As expected, it also highlighted some process issues which the team continues to work with the market to address, including the publication of guidance for managing agents and DCAs, ready to enable a market wide launch later in the year. In preparation for launch we are now encouraging early adoption of the solution with a limited scope of business for market firms to test their processes.


DA Claims Status Tracker

The DA Claims Status Tracker enables market participants to track the progress of any bordereau end-to-end; they will see who it is sitting with, how long they have had it and all historical actions, reducing process delays and queries.

We launched the Status Tracker to managing agents and brokers at the end of November, and all managing agents have been onboarded to the Insights Hub where they can access the solution. The Tracker is now available to all market participants, including Delegated Claims Administrators (DCAs). If you would like to onboard to the Insights Hub and begin to use the DA Claims Status Tracker, please email us.


Features of the claims data standards

The claims data standards will provide structure and consistency to drive claims matching and first notification of loss (FNOL), significantly reducing claims lead times; the data standards will support automation of simple tasks and free up claim handler time for value-add activities.


The core digital claims solution (ICOS)

  • The new core digital solution enables automated validation of claim submissions against policy information, leveraging the core data record
  • It expands collaboration as experts and customers will have direct, appropriate access to interact with insurers, and introduces triaged market workflows enabling full transparency with broker and insurer dashboards and clear audit capability
  • The adoption of ACORD accounting standards will allow full digital submission of a claim as well as managing two-way digital notifications and queries
  • Some notifications will be managed via API, so brokers and insurers will need to be ‘API-ready’ to make the full transition to digital services
  • The introduction of new two-way API data connections to other services include market-wide services in use today
  • Writeback messaging will continue to be supported and is expected to evolve and develop further
  • Flexible direct settlement capability will be introduced to allow swift settlement(s) within a claim

Benefits of adopting the core claims digital solution (ICOS)

  • Enables faster claims settlement with reduction in errors, duplication and queries, reducing claims processing times from weeks and days to hours and minutes
  • Transforms the claims process with a fully automated, real-time digital orchestration service which supports integration with broker and insurer systems
  • Improves operational resilience, removing standing legacy issues, with flexibility for future improvements
  • Increases automation of workflow for assignment of claims, certain decisions and tasks by using a single source of structured data

Benefits of adopting FCP and DA Claims Status Tracker

  • Allows near real time payments to customers
  • Improves fund availability and top up mechanism using a modern payment platform
  • Removes cash call requests made to insurers, reducing friction and operational challenge
  • Provides transparency at each stage of the monthly bordereaux process

Quick recap on key actions for 2022

  • Engage through advisory groups and forums to support build and testing of the solutions
  • Register for DA Claims Status Tracker
  • Use DDM for the submission of in-scope monthly claims bordereaux
  • Leverage market services that support claims, MIS and Optalitix
  • Prepare, apply the entry criteria and adopt the Faster Claims Payment (FCP) solution
  • Implement changes and solutions required to enable digital adoption at market-wide cutover, or implement changes required for transition at market-wide cutover
  • Leverage Writeback adoption
  • Participate in consultation on the claims data standards
  • Adopt transition services if you are a proportional treaty service user

View the end-to-end claims journeys

For the full version of each journey please download the Blueprint Two Interactive Guide second edition.