Pro-Active Claims Management

Pro-Active claims management remains the critical influence in delivering the best opportunity for the optimum outcome in a claims situation; but it does not consist of a single task or mindset.

It consists of a combination of activities, effective processes and the deployment of expertise which when professionally managed and brought together deliver “Pro-Activity”. The insurer may delegate some of these tasks or all of these tasks but will remain accountable for the outcomes irrespective. With that delegation comes an element of risk – reputational and financial – delegation therefore requires regular measurement, oversight and sometimes correction.

In addition, regulatory scrutiny of delegated tasks/outsourcing is increasingly underway with resulting harsh penalties for failing to meet regulatory requirements/expectations. A failure to effectively manage delegated expert resource can lead to leakage, increased indemnity spend, missed settlement opportunities and a failure of cost control. Additionally, over time there is a material risk that the relationship between the cost of products and services and the results/value received become unclear and can be misunderstood.

If a company or insurer does not know their specific costs they are unable to manage, benchmark, improve and connect those costs with the value received. Whether a performance associated or cost related risk, singularly or together they create risk, which has the capacity to be material; delegated expert resource requires regular management and mitigation activities where warranted.