How to bridge the digital claims gap

How to bridge the digital claims gap

Jim Ryan,

Insurtech competition has raised the bar on delivering real-time policyholder services. Now, every major insurance company has a mobile app – every company. Insurers are increasingly offering mobile-based digital claims apps to address their customers’ needs, lifestyles, and emerging preferred interaction channels. And insurance consumers increasingly expect the same degree of “always-available” service they receive from digital suppliers such as Amazon and Uber. But having an app (even a cool app!) doesn’t necessarily translate into being able to meet your customer’s specific demands, or inherently provide them with superior service. In fact, most mobile apps are just provided as another channel, coded in a different language, which then has to be integrated to your enterprise system. This creates digital gaps – barriers between the front-end claims capture and back-end claims processes. And it’s much more than just a legacy systems or processes issue. These digital gaps make your team navigate multiple data sources, systems, and processes, when they should be focused on customer outcomes. They prevent your company from being efficient and creating authentic relationships with each customer.

For example, customers expect that the same digital technology that allows them to submit a mobile claim, will swiftly and intelligently route their claim for processing and resolution. However, incomplete digital claim transformations often exist that create hidden and destructive problems – customers submit claims digitally through a mobile app, but everything that happens post-submission remains a manual fragmented process. The result is a backlog of claim submissions that overwhelm your systems and your claims team.

To deliver timely claims adjudication, fraud detection, and – most importantly – customer satisfaction, you need comprehensive, end-to-end claims management and a new way of customer engagement.

To successfully bridge the data gap, deploy a unified, scalable, and extensible solution.

Bridging the data gap means connecting all your data sources and systems with a software orchestration layer for the entire business process, regardless of the channel through which these business processes originate. Whether you engage your customers through a mobile app, call center interaction, email, or paper claim submission, you don’t need to change your core systems that are in place; you just need them to communicate and work together. This is about more than just APIs and web services. It’s about having a scalable platform seamlessly embedded into all of your channels, and leveraging a central decisioning source to reap the benefits of claims virtualization by addressing the entire claims process, not just the upfront capture.

As insurers go through this digital transformation, a structured journey consists of implementing:

  • Robotic process automation to ensure straight-through handling of digitally-submitted claims.
  • Dynamic case management to transform and expedite workflow, ensuring consistent claims administration and compliance with appropriate guidelines.
  • Artificial Intelligence (AI) and Workforce Intelligence (WFI) tools to provide insight to optimize workflow.
  • A unified customer and claims handler experience through a unified user interface. This user experience enables self-service and guided agent support capabilities. Equally important, a modern UI toolkit ensures rapid and cost-effective updates as business processes change.

The results can be immediate and substantial… while creating competitive advantage.

A digital orchestration layer allows you to improve business and customer outcomes quickly, without the expense and downtime of a complete systems replacement or increase in staff. It provides immediate benefits to business by minimizing duplicate data entry and optimizing work for end-to-end efficiency. The result is a more timely, accurate, and complete customer service experience.

This is a proven approach for global insurers such as:

  • AEGON adopted a digital platform to manage of an array of internal systems – 120 core business processes in all. By automating checks and end-to-end processes AEGON was able to improve first-call resolution to 80 percent and reduce claims processing time by 60 percent.
  • Allianz Global Corporate transformed both their front and back office by streamlining internal processes, which enabled faster transaction processing and more holistic customer service, even for their international insurance customers.

You don’t need to rip and replace your claims software and disrupt your business processes. Successful digital claims transformation enhances your enterprise systems with the capabilities to manage mobile-based, digital claims workflows.

Learn More:


  • Industry Group: 保険
  • トピック: デジタル転換
  • 課題: デジタル プロセス オートメーション
  • 課題: カスタマー エンゲージメント
  • 製品エリア: プラットフォーム
  • 製品エリア: 業務

About the Author

Jim Ryan, vice president and global insurance business line leader for Pegasystems, has more than two decades of executive leadership experience in the global insurance industry advising clients on strategic digital transformation initiatives to streamline end-to-end sales and marketing, and improve customer engagement.