KPIs in Insurance Claims Management

The task of claiming Insurance can easily make the needy ones go nuts. This is because of the heap of documents that are required to be presented to the officials so as to force them release the funds.

However the insurers are in no better position in this regard. They have to filter the genuine cases from the self-constructed ones. This process requires a close scrutiny system and is really a time consuming and complex job. Owing to the plethora of policies the players of this industry run and an equally complicated mesh created by the claimers, a perfect management is what can save both the parties. KPIs organized under various categories on the background of BSC have the potential to address the woes.

KPIs in this regard can be formally organized under four main perspectives- financial, claims processing, operational and efficiency. Financial perspective talks about the financial aspect of the operations and comprises of KPIs like percentage increase in average claim payment per case, percentage change in cost on claims processing, etc. Claims processing perspective includes KPIs such as percentage of records properly documented, claim settlement time, etc. Operational perspective consists of KPIs in the form of percentage of no. of claims and new business policies issued, claim paid amount as a percentage of first year premium, etc. Efficiency perspective takes into consideration KPIs such as percentage decrease in customer complaints, number of litigation per open files, etc.

Insurance is a service- sector operation. So, in addition to the problems that are commonly encountered in this section, some others can be- claimers can pose to misrepresent and shape-up situations to take advantage of the loopholes in the policies. The insurers too, cover-up or hide facts so as to portray such conditions that cause the claimer to lose his/her right. To combat such challenging situations, a suitable and tailored solution comes in the form of KPIs. Once the rules to be abided by are defined, these quantitative measures can be decided for. An in-depth analysis of the internal and external surroundings is to be paid the deserving heed.

With apt indicators, every process is eased out, right from the structuring and employment of claim strategies to assist attainment of business targets. Also, fraud detection becomes easy with clear guidelines. KPIs also help in working for the improvement of claim processes and the kind of customer services provided. With these two aims achieved, everything else falls in place and the organization is free of the issues and problems that crop-up every now and then.

As a sum-up note, KPIs do the task of being specific, measurable, actionable, reliable and time-oriented indicators to create a win-win situation for both the insurers and claimers. Working on a 'value-path', that is the under-lying basis of the concept of BSC; the company can smoothly measure and improve the pace at which it is moving. However, considerable efforts have to go into making a BSC. Once this is done, the stakeholders can heave a sigh of relief and be assured that the path they are treading on is for them.

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