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Claims Triage: How to Classify Your Claims & Plan Under Pressure

By April 30, 2020February 27th, 2024No Comments

Claims triage is much like the workings of a hospital triage.

It is essential for policy administrators to identify the most crucial elements of each claim in order to prioritize the most urgent claims at pique efficiency. These decisions rely on a wealth of knowledge provided by P&C Insurance software for gathering, cataloguing, and measuring claims data.

What is Claims Triage?

Claims triage is the method of sorting high volumes of insurance claims by urgency.

The level of urgency can be indicated by data collected on the claim. With this data, you can act quickly to alleviate concerns from the insured for optimal satisfaction while also minimizing further expenses by understanding the total loss early in the process.

When it comes to catastrophic events which cause a surge of insurance claims, claims triage allows policy administrators to act quickly on the most time-sensitive policy holders. Prioritizing this way allows the following benefits:

1. Prevent further costs from adding to the total by addressing the most critical claims first.

2. Flag fraudulent claims quickly before the claims are further processed.

3. Optimize the timeline for settling urgent claims so that claims that are less urgent and can wait are addressed appropriately in priority.

4. Improve customer satisfaction and decrease turnover by prioritizing policyholders who need the most help immediately.

How Does Claims Triage Work?

First Notice of Loss (FNOL) is important in setting the pace and efficiency of the claims process.

Once the insured takes the first step in providing a notice of their claims, the policy administrator must collect the essential historical and situational data for totaling the loss and providing the insured with their coverage.

Too often, FNOL is seen as the start to a ticking clock for claims to be resolved as quickly as possible. With claims triage, priorities are better set so that FNOL does not indicate the timeline in which claims are handled first. Instead, it is more essential to collect relevant information on the urgency of the claim.

Questions that must be asked to set the level of urgency include:

  • Are there injuries or fatalities involved with the claim?
  • Are the involved assets no longer operable, such as a home that is uninhabitable or a car that is totaled?
  • Does this claim require a field adjuster on the scene for more accurate documentation?

WaterStreet’s Claims Administration solution is fully integrated with Policy Administration and Billing Administration. This allows administrators to view policy details, set reserves, issue payments, and upload supporting documentation and files as needed to track claim progress.

Providing your employees access to a centralized solution allows them to easily process claims with efficiency by having insight into all the relevant data the moment they need it.

How Carriers Can Improve Claims Triage

Not only should carriers make the workflows of these individuals a priority for best managing claims and expenses, it’s also important to collect this data for aligning historical trends. Cloud insurance software helps unify the company’s data to make this a reality.

Identifying how the level of priority depends on trends in claims data can help guide long-term growth towards efficiency.

Reach out to WaterStreet Company today to request a consultation and demo.

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