Overview of the Claims Handling Process
A leading UK pet insurer engaged Procurato to evaluate its claims handling process and establish a baseline for assurance. With increasing regulatory focus on Consumer Duty outcomes, the insurer sought to ensure that its claims handling adhered to service level agreements (SLAs) while delivering positive customer outcomes. Procurato provided a tailored solution to audit the claims handling process and deliver a thematic review of operational performance.
Objectives
To meet the client’s needs, Procurato aimed to:
- Audit claims handling performance to assess quality, SLA adherence, and compliance with Consumer Duty requirements.
- Reconcile bulk fee invoices with processed claim volumes for greater financial oversight within claims handling.
- Establish a baseline for ongoing assurance activities and identify areas for improvement in claims handling.
- Provide actionable insights to enhance operational efficiency and customer outcomes across claims handling.
Key Activities
Procurato conducted a detailed audit of a sample of claims to evaluate quality, SLA adherence, and opportunities for improvement within the claims handling process. An in-depth thematic review of key operational metrics within claims handling was also delivered, focusing on:
- Indemnity spend analysis to detect potential leakage or anomalies.
- Claims process adherence and KPI performance across the claims handling process.
- Complaints handling to uncover systemic issues and risks.
- Good outcomes assessment, emphasising vulnerable customer management within claims handling under Consumer Duty requirements.
Procurato also provided the client with comprehensive reports detailing findings, recommendations, and actionable next steps to strengthen the claims handling process.
Benefits Achieved from Optimising the Claims Handling Process
Collaborating closely with the client’s teams, Procurato delivered:
- A clear baseline for claims handling performance, enabling the client to monitor and improve operational outcomes.
- Insights into potential inefficiencies and risks in indemnity spend and SLA adherence within claims handling.
- Enhanced operational oversight through reconciliation of financial and claims data across claims handling.
- Recommendations for claims handling improvements to better align with regulatory expectations and customer needs.
