An efficient claims operation is critical to the success of every insurance provider. But it’s hard to get this right, as claims processing is a complicated business function with many moving parts.

The pressure on many claims teams increased dramatically over the last few weeks, as the COVID-19 lockdown sparked a rise in claims and disrupted how teams work. Although this is a multi-faceted crisis, your team’s ability to keep up is directly linked to the tooling available to them. The right technology will increase their efficiency and their delivery to customers.

Over and above the immediate crisis, investing in your claims team’s tooling will also enable you to:

  • reduce costs by increasing the efficiency of your team
  • deliver a world-class claims experience to your customers
  • set your brand apart from competitors

Mr Price has been using Root for more than a year now, tapping into all the benefits brought about by an API-first, end-to-end insurance platform (like automated sanctions screening, to name but one). In the recent weeks, this has also allowed an unexpected benefit: their claims team has been able to seamlessly continue their operations remotely without compromising efficiency.

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Why efficient claims processing is hard

Processing high volumes of claims efficiently and fast is not easy. Here’s a list of the typical responsibilities of your claims team:

  • collect relevant claims data
  • assess claims against a plethora of rules and criteria (weeding out invalid or fraudulent ones)
  • communicate with customers about progress
  • collaborate with the underwriter (and sometimes reinsurer) on decisions
  • fulfill approved claims
  • submit monthly daily claim reports to the insurer (yes, regulations now require you to keep your insurer fully up to date on a daily basis)

Dropping the ball at any stage can have significant knock-on effects, ultimately compromising the customer’s claim experience. It can also increase complaints substantially - which can hurt your reputation.

Claims teams lack sufficient tooling

Claims teams often have to make do with limited tooling - something which directly hampers their efficiency and effectiveness. Here’s what your claims team’s reality probably looks like:

  • Claims information is scattered across different places: some in a shared file system, some in a shared spreadsheet, and some in emails. This means a lot of manual work is required for keeping track of a claim and locating information.
  • Because of how files are shared and stored, only one agent can work on a specific claim at a time. This means agents spend time waiting for each other for tasks that can be performed in parallel.
  • Collaborating with the various parties involved in processing a claim is cumbersome, involving emails, phone calls and shared files. This means communication is siloed and takes more time than it should, raising the likelihood of serious errors.

In short, claims teams don’t have a central, easy-to-access place to manage claims end-to-end. This results in a complex workflow with lots of room for error, unnecessary stress for your team, and a sub-optimal experience for customers.

How Mr Price increased the efficiency of their claims team

Mr Price first started using Root in November 2018. Root’s technology is enabling their claims team to process hundreds of claims per month, much faster and more streamlined than before. Recently, amid national lockdown, it also meant all their claims agents could start working from home with no disruption to their services.


Here’s how the Mr Price claims process works:

Logging claims

A customer can log their claim by phone or email. All claims data is then saved on Root and can be accessed by all the approved claims agents, via the web. Multiple claims agents can access the claim file at the same time, and amend the claims details.

A configured digital claim form and workflow provides an essential guide rail that allows agents to correctly capture claim information in a standardised format, with a full audit trail.

Once all the claim data has been captured, the claim is sent for review. The claims assessors are automatically notified that a claim requires their attention.

Assessing claims

Collaboration on claim decisions happens directly on Root. Notes can be shared directly on the platform where it is accessible by everyone involved. No more emails with all the inefficiency and risk they bring.

A two-step authorisation process allows for an appropriate level of oversight and separation of duties between “assessor” and “approver” in the claims function.

Once a claim has been assessed, the suggested claims outcome is sent for review to the claims supervisor. The supervisor receives a notification to review the claim decision.

Root is also set up at Guardrisk, Mr Price’s underwriting insurer, which streamlines repudiations in the claims process. This means that when a repudiation is escalated, it’s immediately available with full context (all captured info, files, comms, and audit trails) to Guardrisk’s claims team who can now respond much faster than normal. No more shared SFTP folders or sensitive info over email required.

During all of this, claimants and beneficiaries are automatically kept up to date on the progress of the claim.

Once a supervisor approves a claim on Root, the claim payout (or fulfillment) automatically appears in the payments tool on the Root dashboard. It can now be actioned directly by the finance team.

Paying claims

All the claim payout and fulfillment requests are neatly aggregated for the finance team to action directly. Payments can now be extracted in the bank’s required format for action, or processed manually. The finance team can also easily click through to the claim to review any outliers or anomalies.

Once a payment is successful, the relevant claim is marked as such and closed on Root. The platform automatically informs the claimant and beneficiaries that the claim has been paid.

Claims reporting

Finally, bordereaux and other claim reports are configured in the required format and automated on Root. This enables Mr Price’s underwriter, Guardrisk, to stay up to date with all the claims being processed.


Keen to take your claims team to the next level?

If you want to learn more about optimising your claims operations, schedule a free consultation now.

Investing in your team’s tooling is not just an expense - it’s an investment in a real business differentiator.