The Claims Challenge

An insurance company’s strength comes from its ability to fulfill the promises it makes to its policyholders and nowhere is that promise more evident than in Claims. Claims payments account for the largest monetary outflows for any insurer and provide the greatest opportunity for fraud and leakage. 

The Need for Speed

Consumers and businesses expect their claims to be paid quickly and accurately, but paying a claim without a thorough review of the circumstances can result in overpayment or the payment of fraudulent claims. Delays in paying claims can result in disgruntled customers, loss of reputation, and an increased likelihood of costly litigation. Insurers need to pay claims quickly without benefiting fraudsters and without penalizing legitimate claimants.

Subrogation Recoveries

In many situations, insurers pay claims to indemnify their own customers and fail to seek remedy against the party that was ultimately responsible for the loss. Yet in other situations, insurers waste valuable resources attempting to subrogate claims against parties that have little or no ability to pay thereby adding insult to injury by increasing the adjudication cost of an unrecoverable claim.

The Valen Solution for Claims

Using predictive analytics, Valen creates models that identify those claims that are least likely to be fraudulent and enables the insurer to expand straight-through-processing capability to a larger proportion of all claims. This results in shorter cycle times for all claims on the average and it gives the adjuster more time to allocate towards investigating claims that have a greater potential for fraud or litigation.

 Valen also creates subrogation models that predict the potential for recovery as well as the probable magnitude of the recovery. Employing such a model enables the insurer to focus subrogation efforts on those claims that will provide the greatest benefit to the company.