Importance of Claims Investigation
Underwriting and investigations are the two most imperative perspectives in running an insurance company. In today’s business environment, where competitiveness and financial gain are vital business cornerstones, claims investigation can serve as a market differentiator that places insurance agencies at the forefront of industry leadership and innovation.
To be effective, insurers must improve the operational productivity of their claims processing and assemble a business model that can minimize claims costs and also eliminate unnecessary expenses associated with handling real and fraudulent claims.
Many insurance providers have a variety of claims operations, personnel, and units that focus on the products and services (non-life and life) they offer to individuals or in various business sectors. This model often generates gigantic claims operations with remarkable unit designs, systems infrastructure, and procedures for each market or line of business. In addition, in high-volume or exceptionally complex operations, fraud, waste and abuse claims are the most distressing to insurers. This is where the claims investigation process works wonders and helps insurers gain efficiency in their daily operations.
Understanding Claims Investigation
The Claims Investigations process is one in which Insurance Companies, Insurance Examiners or Investigators obtain data to evaluate a claim. So it might require looking at documents, finding witnesses, going to talk to people, evaluating property eg vehicles, accident sites, to give a few examples. Additionally, these investigations can lead to taking pictures, videotaping, finding witnesses, speaking with victims, claims administrators, and much more. In doing so, insurance companies are looking for capable partners who can provide all the services of the claims investigation process, and this leads to the need for a third-party administrator who can work in conjunction with insurance providers to resolve claims and provide valuable suggestions
Various Forms of a Potentially Fraudulent Claim
Fraud is a general term used to describe an act of deception by an individual or group. This act of deception can come in various configurations. For example, insurance investigators try to uncover people who make false claims with the specific end goal of getting insurance money. Likewise, intellectual fraud occurs when counterfeit items are impersonated or sold as genuine. Mortgage fraud occurs when someone has tampered with documentation to ensure that a loan is processed. Since each of the aforementioned claims falls under the category of fraudulent claims, having a certified claims investigation agency can only gain efficiency in each and every step of claims adjudication.
As you must be aware of the fact that fraud is a gigantic problem that costs insurance companies billions of dollars every year. In such a scenario, having a trusted insurance claims investigation partner can take great advantage of the workload of an insurance company’s internal staff. And with integrated platforms and digitized reporting, it can present you with real-time information on every claim investigated.
Following these points can help you assess the quality parameters of the claims investigation service and verify how well it is a good fit for your business.