Insurance "claims time limit" has been redefined: only "fast reporting + fast payment" is really fast claims

Behind the insurance "claim difficulty", the claim time limit problem is a major pain point. Users in the application of insurance claims, due to the lack of materials back and forth is extremely common. In recent years, many insurance companies actively improve the efficiency of claims, has been able to reach the day claims, or even seconds to pay, which is very different from the user perception of "long time to pay".

In the view of industry insiders, the traditional insurance audit link needs to have a huge manpower support, and the professionalism requirements are extremely high, the need for medical, pharmacy and other backgrounds, the audit team alone, the human cost is a considerable expenditure. The replacement of claims adjusters by claims rules can reduce the error rate and improve the efficiency of insurance claims. Taking the claims processing time of "Good Medical Insurance" as an example, from October 2017 to September 2018, the claims of Good Medical Insurance were processed through offline mailing of materials, and the claims were completed within 15 days on average. Through the introduction of intelligent claims verification tools, system optimization and rule process reduction at the front end, the claims timeframe has been reduced to about 3 days in three years, and more than 90% of cases are now completed within 2 days.

In recent years, insurance companies have been increasingly focusing on user experience and improving the efficiency of insurance claims service, and the "claims timeframe" is an important indicator reflecting the ability of insurance companies to provide claims service. 2021, the average timeframe for claims settlement by insurance companies is mostly within 2 days. However, this is not a time frame that is commonly understood by insurance consumers.

Li Yong pointed out that this time limit is the concept of average time limit, the average time limit and the time limit with the user perceived a relatively large difference, the main reason may be that each insurance company handled the composition of the case is not quite the same, for example, there are a large number of small amount of outpatient type of cases, the complexity of its relatively low, so the length of time for the claim will be relatively low. Another example is that the processing of group insurance business as a whole is relatively simple, it is collected by a person to the resident unit, after the collection of batch processing, the user's perception is that the reimbursement is very slow.

In addition to the differences in the types of insurance operated by each, there is also the problem of statistical methods. Li Yong pointed out that we see some insurance companies online to collect all the claims materials, after the completion of the audit will require the user to send the original to the original received as a point in time as the materials complete point in time, so that the time to get the closure of the case will also be a lot shorter than the user feels the actual handling of the claims timeliness, length of time.

It is worth mentioning that, for some small cases, the insurance company's claims report can already do day claims, or even second claims. Li Yong to the same industry to make "1 day fast compensation" commitment of the two insurance companies, for example, A insurance company is less than 20,000 yuan, B insurance company is less than 10,000 yuan within the case of 1 day compensation commitment, estimated that A insurance company can only cover about 35% of the case volume, B insurance company less than 50% of the users can feel, due to the existence of the claims material was repeatedly called back The majority of users have a relatively poor feeling about the so-called "1-day fast payout" due to the fact that the claim documents have been called back several times.

Recently, in the ant insurance claims technology upgrades online conference, a number of insurance agency claims responsible for the claims, including the time limit, including the pain points of the claim to explain the professional point of view.

In the People's Insurance Company Health Internet Insurance Division Claims Division head Ji Kui view, the pain point of insurance claims is the growing claims customers for claims expectations and the actual payout of the difference between the situation. Specifically, it mainly includes whether it can be paid, how fast it can be paid, and the service items that can be paid. Over the past decade, many of our peers have been looking for reasons for customers to settle their claims, announcing their commitment to the timeframe for settling claims, and implementing service programs such as advance payments.

Cai Liming, general manager of Ping An's health insurance claims department, pointed out that the three major pain points in health insurance claims include customers' lack of understanding of the reasons for rejecting claims, inability to provide the materials required by the insurance company, and the issue of timeframe. Most insurance companies are already very fast at settling claims, but it is still an average timeframe, and the overall processing timeframe is still on the slow side for more complicated cases, especially those that need to be investigated. Customers are not sure if they will be paid while they are waiting, and they may call for advice or to press for compensation.

Wang Jianmin, general manager of China Life's underwriting and claims department, said that medical insurance accounts for more than 90% of the industry's claims, and the amount of money is generally small claims. For this kind of high-frequency and low-cost insurance, customers are more concerned about the speed and convenience of the application. On the one hand, whether it can or can't be compensated, it is fast and convenient to complete the claim application, on the other hand, how much can be compensated, how much is compensated, how is it calculated, and the conclusion is clearly shown to the customer. For low-frequency and high-cost insurance such as critical illness insurance, the conclusion of the claim is more important than the length of time it takes to settle the claim.

The Insurance Association of China pointed out that most insurance organizations have low online coverage of customer service claims, poor timeliness of claims, and poor after-sales customer experience, which has led to an increase in Internet insurance business along with a growing trend of customer complaints. In response to the situation, insurance companies should strengthen their online claims handling capabilities, improve the online coverage of customer claims, build differentiated service capabilities for customer service claims, optimize after-sales customer experience, and overcome the communication costs for consumers and insurers due to the natural attributes of Internet insurance such as massive, fragmented and innovative with advanced Internet technology.

"In the last 3-5 years, the biggest change in insurance claims is the onlineization of claims service." Cai Liming said that thanks to the promotion of Internet insurance platforms such as Ant Insurance, customers can report cases and submit materials online, and insurance companies can give customers a variety of forms of operational guidelines in the process of online services, and in the progress of claims processing, customers can get information in real time, which is greatly convenient for customers, and the audience is very wide. The first thing you need to do is to get the information you need from your computer, and you can do it in real time," he said.

In Cai Liming's view, the onlineization of claims service not only significantly improves the timeliness and efficiency of claims, but also urges the insurance industry to be more standardized and transparent in the claims standard and claims process.

The Insurance Technology "14th Five-Year" Development Plan released by the Insurance Association of China shows that during the "14th Five-Year" period, the industry will be pushed to realize the automation rate of claims of more than 40%. In Wang Jianmin's view, at present, whether it is life insurance, health insurance or property insurance, the industry claims automation rate level is relatively low. In recent years, the industry has been actively exploring refined scenario design and refined customer experience in the field of technology. Take the claims brain project as an example, in the customer data upload process scene, the application of AI technology can recognize 107 kinds of medical and claims vouchers, and complete the clarity, completeness and recognition of uploaded data.

For example, when a user uploads a photo of a hospitalization certificate, the system will tell the user that the document to be uploaded is a hospitalization summary, and show the schematic diagram of the hospitalization summary and how to get it. With the help of Claims Brain, 90% of users can pass the first time they submit documents, basically realizing "one-time submission". This not only saves users' time and effort in reporting cases, but also helps to improve the efficiency of insurance companies in filing cases, so that auditors do not need to review and return the reported materials several times, and are able to enter into the compensation process more quickly.

Daily Economic News