Category Life Insurance

Technology can ease the claims process burden and play a vital role in fraud detection

13 March 2024 Hollard

Technology has the power to revolutionise the insurance claims process, making it simpler and less stressful for clients during challenging times. So says Senior Claims Manager at Hollard Life Solutions, Avinash Baboolal.

The insurance claims process has long been associated with complexity, adding stress to claimants already facing challenging circumstances. However, recent advancements in technology are reshaping this process and changing perceptions of the process.

Avinash Baboolal, Head of Claims at Hollard Life Solutions says: “Hollard Life Solutions recognises that when a client files a claim on a life insurance policy, they are experiencing a significant life-changing event. The claims process should, therefore, not add to their already stressful situation.”

One of the crucial ways that technology is improving the claims journey is through the use of artificial intelligence (AI) tools, which help streamline the assessment process, reducing the time it takes to process a claim, he says. In addition, new technology improves communication with clients and plays a vital role in fraud detection.

According to data from the Association for Savings and Investment South Africa (ASISA), South African life insurers paid out a total of R287-billion in claims and benefits to policyholders and beneficiaries in the first half of 2023. This highlights the importance of insurance in providing financial security during times of need.

Baboolal notes that the insurance industry is undergoing a significant shift, particularly in the way claims are handled – and technology has a big part to play in that. Recognising the importance of easing the claims process, Hollard Life Solutions is among those insurers leading in implementing technology to ease the convoluted and stressful claims process. The Covid-19 pandemic also accelerated the insurance sector's move towards digitisation. Self-service portals now allow clients to manage their policies, submit claims, and update information conveniently and securely, from anywhere.

Gone are the days when the claims process relied solely on customers submitting claim information. Through strategic partnerships and innovative processes, policyholders now have access to their policy information via the customer portal. They can also submit claims through WhatsApp. This has improved efficiencies, significantly reduced turnaround times, and enhanced the overall customer experience.

Baboolal explains that data analytics has also emerged as a powerful tool that enables insurers to analyse trends, solve claim challenges, and improve claims-related decisions. AI and machine learning continue to further enhance this capability, enabling predictive modelling for fraud detection and claims automation.

“The use of technology is implemented through our direct book of business and is a testament to our commitment to leveraging technology to improve the customer’s overall user experience. We are always looking at ongoing efforts to enhance the claim processes and outcomes for customers.”

As the insurance industry continues to evolve, driven by technology and innovation, the focus remains on providing policyholders with an empathetic and seamless experience when they need it most.

“Our aim is to make the claims process as easy as possible,” Baboolal explains “We have a simple claims process whereby all claims are logged into a workflow and any requirements that are needed are easily identified through this process. Once claims are logged, an assessor evaluates the risk of the claim and makes a decision. The client or their broker is then advised of the outcome of the decision. If a claim is approved, a payment is made.”

According to Hollard, most issues in the claims process arise from delays in the submission of all required documents. Fraud also remains a challenge that insurers have to tackle, with clients submitting false information that then halt payments.

Baboolal shares that to facilitate a smoother claims journey, advisors should encourage clients to ensure their premiums are up to date, to understand the coverage provided by their policy, and to verify that all personal details and beneficiary information are accurate.

When making a claim, clients should be encouraged to provide all relevant information including the policy number, identity documents, and any documents pertinent to the claim, such as a death certificate – in the event of a death claim. Brokers and advisors can provide guidance to clients on requirements for claims.

While emphasising the importance of human interaction in the insurance industry, industry players need to acknowledge the changing landscape of claims processing through the integration of AI-driven tools such as chatbots, optical character recognition, advanced analytics, and customer mobile apps. These innovations, combined with a user-friendly self-service portal, are expected to play a significant role in simplifying and enhancing the claims process for clients into the future.

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