Tell our readers a little about yourself, The Risk Store, C-MAP and what you do?
I’ve been in the industry for over 40 years. I’m an underwriter and claims assessor by training but have also run sales teams for life companies, established the country’s first life insurance product research company, co-owned and run a specialist risk dealer group for over 10 years then become a gun-for-hire industry consultant, Finally I established a brand – The Risk Store – ten years ago.
What is Pete’s role in the business?
This new venture took off faster than anticipated. Pete Wincott stepped in as my business partner and our Managing Director. His great relationship and business management skills drove our growth and got us through a few industry and economic challenges. Ten years on, he has developed excellent industry and technical knowledge, but it was his lengthy background in consumer marketing that spawned our ‘client experience’ consulting work and C-MAP.
Who is The Risk Store?
The Risk Store is an independent specialist training, consultancy and content provider for the life insurance and superannuation industries in Australia and New Zealand. We operate a web-based life risk ‘library’ for advisers, under ‘The Risk Store’ brand. Advisers (and insurers) become members under a 24/7 subscription model which offers a huge range of unique technical and soft skills resources on ‘all things life insurance’. Some of your members may know us as the exclusive collator and publisher of the life industry claims paid statistics for the last ten years. The stats are available to Risk Store members only and are a popular tool to counter media and consumer cynicism!
We also conduct group training and provide PD day facilitation.
The last few years though, has seen our industry consulting business grow significantly and working on ‘the claims experience’ has become our focus. This coincides with insurers’ and super funds’ increasing concerns around claims delivery.
This particular focus on the claimant experience: why is that?
No one was even acknowledging, never mind actually reviewing their actual claimant experience until we started discussing it with insurers years ago. We suspect some insurers still don’t really get it. That has got to change. Insurers need to become the ‘hero’ in claims. In these days of consumer awareness and with the ease of going public on institutional shortfalls, no longer can a poor experience be allowed to survive.
Besides, the best experience is what all policy holders deserve. Even if their claim is declined it can be managed expertly.
So – what spawned the C-MAP service?
How can advisers make their insurer choice more robust than by purely following product research outcomes? Isn’t the likely claimant experience a valid factor to take into account? We think so – but nothing delivered this type of input for advisers. Until we developed C-MAP to measure the true claimant experience. And when this was ready, we recognised it was also a blueprint that insurers can use to analyse and improve claims processes towards an excellent experience that could be regarded as best practice. Hence – C-MAP for short.
What is C-MAP?
C-MAP is our unique, granular methodology called the Claims Management Analysis Programme. We are independent so the results are too. We assess and analyse every element of claims management and administration, much of this reviewed on actual, live files. A claims experience should be so much more than just “was the claim paid or not paid?”
C-MAP is often incorrectly perceived as an ‘audit’ tool or a ‘ratings’ service. It’s neither. First and foremost, it is a business assessment tool for management. We gave it a rating function because insurers’ sales and marketing departments wanted a device to use to inform their advisers how well they rated.
C-MAP’s been delivered to three retail and five group insurers – some multiple times. We have just delivered C-MAP to BT Life for the third time in six years, with each result better than the last. Whereas C-MAP did not drive and/or inform all the strides BT has achieved, then it has been the trigger for those strides to be achieved, then endorsed.
In your experience, what is your current take on the state of claims handling in the life industry, both retail and group?
Plenty of claims are being paid. That’s great. But broadly, the ‘how’ is okay. Just okay. Okay isn’t acceptable in our opinion and we doubt it is for policy holders and their advisers. But perhaps worse is the great divide between the best and the mediocre. We have seen very sub-standard and very excellent claims handling and we know what can be done to standardise industry quality of experience.
I guess that is why we get called in by our clients.
There is a very long way to go.
Looking ahead, where do you see the most likely/necessary areas of change that will impact on claimants?
Clear, timely, transparent and informative communication is the number one area for improvement. Quality assurance across all administration and case activity, including robustness of the peer review process, would be the other key priority.
What role do you see technology playing in the advancement of claims management?
Technology cannot replace human intervention, support and communication, but areas such as submission and acknowledgement; claimant data metrics analysis and reporting; medical report gathering (hello federal government!); managing health preventative incentives; and reducing the claims touch points all have great potential for technology-delivered efficiencies.
What are the current key challenges in group claims management?
One challenge arises above all others and will be the most impactful if it is conquered. The multiple levels of stakeholder: insurer, trustee, administrator and in some cases employer, must be subsumed inside the management process, so that the claiming member enjoys a confusion-free, seamless path through the claim despite the concurrent and discrete roles and functions of each stakeholder.
What are the top 5 things you feel insurers can look at doing to improve their claims processes, policies and procedures towards a brilliant claimant experience?
- Can we say “start by engaging in a C-MAP conversation”?
- Don’t view claims simply as a business activity, from A to Z. That’s no longer acceptable. View it as a wonderful opportunity to showcase to your policyholders, claims recipients and stakeholders the value of delivering on ‘the promise’.
- Embark on a long-term plan to commit to QA; involve everyone connected with claims, internal and external, as part of the process. Adequately resource the plan and don’t skimp, financially or with the right talent.
- Be transparent. Be inclusive.
- Be critical. Be honest – about how well (or not) you deliver the claimant experience. Question “can we do better?”
The Risk Store and C-MAP / Insurance Industry Consultant
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