Altus Insurance whitepaper spreads - Flipbook - Page 31
Reaching our destination –
de昀椀ning the model
Chapter Summary
• When embarking on a claims transformation programme, insurers must 昀椀rst ensure there is a detailed
understanding of the current state and the target operating model, de昀椀ned in accordance with corporate
objectives, alongside clarity of vision and a sustained focus on delivery.
• Target operating model (TOM) design is about more than just IT, as it encompasses factors relating to
people, process and technology.
• In this section, we include a diagram of a high-level operating model for claims, and highlight key areas
of change which can enable optimisation of customer service and internal operations.
• The supply chain is fundamental to the ful昀椀lment of claims. By designing an architecture which brings
suppliers close to the mechanics of the insurer, communication, control and transparency can be
improved for all parties, in particular the customer.
• The customer experience, from the point of quote through to claim noti昀椀cation, claim settlement
and renewal is absolutely key. Maintaining a focus on both the high level process and the individual
interactions between customer and insurer, will enable the insurer to design a new model which delivers
a better service to its customers bene昀椀ting from the improved e昀케ciencies (and customer retention) that
follow from these changes.
When it comes to claims transformation, there are two crucial steps to be taken
before any of the building work can start – a common understanding of the
current state of claims management from end-to-end, and an agreement of the
business objectives.
Key considerations for a new model –
Process, People and Technology
The 昀椀rst priority is to make sure there is a common
understanding and documented view of the current
state of the claims process for all parts of the function
that are in scope. This stage isn’t about what the
claims process should look like - simply what does
it look like today.
In tandem, it is necessary to agree upon the rationale
for change and the key objectives. It is critical that
customer outcomes are at the forefront of the new
vision, to reduce the risk that changes with a real
customer bene昀椀t are delayed or de-scoped due to
competing priorities. Change is di昀케cult, particularly
in a technically complex area like claims, and
requires a clear vision, commitment, and focused
e昀昀ort to deliver.
As outlined above, one of the key errors made in the
past is to assume that technology will provide the
answers to the problems and ambitions identi昀椀ed.
In our experience, technology is rarely the whole
solution.
It is important to look at the process ‘as is’, at
both a low level, with a full understanding of all
touchpoints and their cumulative impact, and at the
highest possible level, the start- and the end-point
between the customer and the insurer for an endto-end claim. This allows the insurer to understand
how to design the claims processes that underpin
the Target Operating Model (TOM), utilising the
right combination of its existing tools, new product
o昀昀erings and innovative technology, including AI
solutions where there is a clear bene昀椀t. Once the
internal capabilities of the TOM are better understood,
insurers can make clear-headed decisions on the
extent to which claims are managed in-house or with
support from third party administrators (TPAs).
Ultimately, the future state needs to be underpinned
by both strong technical knowledge to ensure claims
are managed correctly and an MI and oversight model
that enables the insurer to continuously improve and
adapt to changes in the external environment. These
may be supported by solutions with AI elements, but
they will ultimately need human experts to assess and
make the right decisions.
31
