Claims Processing

Introduction

Autogere is part of one of the largest financial groups in Portugal, the BCP Group. It was founded in 1997 with the objective of integrate the car claims division of five of its insurance companies, Ocidental, Médis, Império Bonança, Seguro Directo and ICI – Império, Comércio & Indústria.

With the creation of Autogere it was intended to simplify the claims process for both customers and staff, reduce the overall costs associated with processing claims and to achieve a clear point of difference from competitors in the Portuguese market. This was no easy task, as each company had an individual image with very distinct characteristics, which the company wanted to maintain, whilst at the same time creating a common claims processing front-end based on best practice from all five companies.

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Situation Analisys

Anyone who has ever made a car insurance claim knows just how frustrating the process can be – phoning the insurance company, filling out endless forms, chasing the insurer for action at every turn. It can be a time-consuming process and is definitely something we can all do without at a time when we’re at a low ebb anyway.

But the process is time-consuming for the people on the other end of the phone dealing with your claim. A single claim can generate reams of paperwork and associated actions that need to be carried out before the claim can be put to bed and settled satisfactory. In the case of a car accident, for example, a phone call from a customer making a claim initiates a whole chain of events that need to be carried out in a specific order and with a great deal of follow-up involved. Things like contacting a car hire company for a replacement vehicle, obtaining estimates for repair and commissioning the work to be carried out, and so on and so forth. This is a lengthy and laborious process, both for the insured party, sitting at home car-less and possibly injured, and for the insurance company responsible for settling the claim through the labyrinthine claims system.

The implications for the insurance company trying to run a profitable business and motivate and retain staff in an environment as complex as this are obvious. Every claim has to be handled multiple times, people have to be chased for the next action to be carried out and there is an enormous opportunity for mishandling of claims, wasted time and money. The consequences for customer satisfaction, productivity, profitability and staff retention are clear.

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Objective

What sets the Autogere system apart from other claims processing systems is the idea of developing a single user interface, able to support all claims processing operations in a highly systemised and automated way, with a high degree of integration between all the different sub-systems and users.

The workflow solution implemented is not limited to sending tasks internally amongst Autogere staff, but encompasses a whole chain of third parties, usually preferred suppliers, with whom Autogere set up privileged channels of communication. This includes repair shops, rental car agencies and external damage estimators amongst others.

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Solution Description

Every function within Autogere is now driven by workflows, often triggered by a single phone call from the client.

The preferred suppliers receive electronic requests to service cars, send out hire cars, survey damage or whatever, generated, allocated and routed automatically by Mosaix’ ViewStar Workflow Management features. The workflow then awaits the response and routes it to the appropriate agent depending on content and data.

The entire system is based on three broad functional components: call management, work management and document management. Under the new system, all calls are answered following scripts based on previously defined decision trees incorporating business rules and commercial requirements. Every type of request is handled using these scripts, which guide the agent through the dialogue with the client, something which has proven to be an excellent training tool for call centre agents. With this easy transfer of information, the company is able to balance the workload within the call centre across multiple agents, as it negates the need for the client to speak to a specific agent regarding a specific claim.

The second component of the system is work management. This means that technology is used to ensure the right person carries out the right actions, in the right way and at the right time. In particular, the Autogere claims processing system has been designed to only feed the users with value added tasks: those tasks that no system can perform and therefore should be allocated to an experienced and knowledgeable person.
The final component of the system is document management.  By its very nature, auto claims processing is extremely paper intensive, which translates into high costs and low productivity levels because of manual document handling.  So, all new documents relating to a claim are scanned and indexed on arrival at Autogere and any supplementary documents required to progress the claim are created automatically, like faxes, reports and so on. The system also allows the input of digital photography for the inclusion of photos of damage in reports etc and the automatic integration of fax documents into the system. Other key features of the document management function are one key indexing to simplify and speed up the filling out of data entry forms and remote access for third party participants to view and manage claims and sub-claims.

Currently the system was rolled out to the Autogere headquarters’ 150 employees, but the total number of users multiplies considerably when you consider the other parties involved in the claims process - auto shops, rental car agencies, medical facilities, investigators, claims settlers, external auditors, legal departments and so on. 
In spite of the large numbers of people involved in the claims process, one of the biggest achievements of the system is to ensure that the majority of claims are processed during the first phone call with the client, reducing significantly the time and resources necessary to process a claim. 

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Benefits

• Allows to improve customers service of BCP Group insurance company clients, reduce the litigation cases, reduce clinical assistance costs and improve reserves and payments management.
  
  
• It assures one high degree of systematization, a great level of automation and a significant reduction of the time and the resources necessary to process accidents automobiles.
  
  
• This solution is scalable both Horizontally and Vertically, it means that the system can grow by adding extra servers to the basis of the solution or grow based in the use of additional disk space.

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Details

In 1998 Methodus got an important international recognition that confirmed the quality of its work on the IT market, namely in the Automobile Claims Processing Solution developed for Autogere.

Methodus won the Gold Medal of the European Giga Excellence Awards for the best European systems implementation in the Workflow and Process Management category. The application presented by Methodus was unanimously selected as the best by the several specialists that compose the jury for the Giga Excellence Awards.  

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