Claims Management across the insurance claim lifecycle
Key Takeaway
Claims Management covers the insurance claims lifecycle from first notice of loss to closure. Its integration with Policy Administration on the Digital Insurance Platform lets the policy help define each claim. The skills-based routing tools of Agentforce Financial Services assign each claim to the right resource, based on the claim and its policy.
An insurance claim is a request for payment from a policyholder to their policy provider to cover a loss. Claims Management is the Digital Insurance Platform module that supports insurers through the entire claims lifecycle. In a customer scenario, a consultant looks for typical pain points, such as disconnected service and claims platforms, manual claim assignment, and repetitive adjuster tasks. The consultant then matches each pain point to its lifecycle stage and to the Claims Management capability for that stage.
The Claims Lifecycle
Different lines of business can have different claim processes. Even so, the lifecycle of most claims has six stages.
| Stage | What happens |
|---|---|
| First notice of loss (FNOL) | Someone reports details about the loss, theft, or damage of an insured item, or about an injury to an insured party. |
| Segmentation and assignment | The insurer determines the claim's characteristics and segments the claim based on them. The claim is then assigned to the appropriate handling resource. |
| Workload management | The claim is broken into tasks, which are prioritized, monitored, and resolved. |
| Investigation and documentation | The insurer investigates the claim and determines the amount of loss or damages the policy covers. |
| Financials and adjudication | The insurer compares the specifics of the claim to the policy's benefit or coverage requirements. The insurer then pays or denies the claim. |
| Closure | The claim is settled. |
Insurers generally track the time to closure on a claim carefully as a key performance metric.