Claims Management

Claims management costs comprise a significant amount of some insurance companies’ operational expenses, encompassing up to as much as 20%. Considering that the claims process directly affects customer satisfaction, claims management is one of the most critical functions of your business. Reducing claims management costs, even by a small amount, can have a significant, positive impact on your company’s performance.

Claim FormClaims management solutions use predictive analytics to help you reduce cycle times and minimize costs while improving the productivity, accuracy, and consistency of your claim handling process and minimising the risk of fraud.

Claim fraud is increasing and the focus on claim fraud is increasing as well. 1 out of 10 insurance claims is fraudulent. How do you spot those before a hefty pay out is made? Most fraud solutions on the market today are rules-based. Unfortunately, it is too easy for fraudsters to manipulate and get around the rules. Predictive Analytics, on the other hand, uses a combination of rules, modelling, text mining, database searches and exception reporting to identify fraud sooner and more effectively at each stage of the claims cycle.


Claims management solutions from Presidion can support your claim handling process by enabling you to:

  • Combine risk profiles with business rules to resolve legitimate claims in as little as one phone call.
  • Stream line  claims processes and decision-making, and implement continuous process improvement.
  • Make better use of skilled investigators by enabling your staff to focus only on complex claims or high-value suspicious claims.
  • Minimise claim payments and reduce fraud with real-time alerts of suspicious activity.
  • Improve customer service and keep costs down by streamlining the claim handling process; for example, industry studies show that fast-tracking legitimate claims reduces customer frustration and minimises the likelihood that policy holders will take negative action.
  • Decrease the amount of time it takes to process a claim by several days on average by improving claims routing, providing adjusters with suggested tasks and real time assessment of adjuster statistics.
  • Improve subrogation results by focusing on the claims more likely to pay you back.
  • Build and use methods for scoring claims particular to state differences, lines of business, or times of catastrophe.

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Claims Management Resources

Case Study

Santam saves millions in processing claims and detecting fraud

Santam processes its claim 70 time faster using Predictive Analytics Solution and detect multi-million fraud cases.

  • ROI: 244%
  • Payback: 3.7 months
  • Avg annual benefit: R34,407,024 (US$3,815,085)

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Infographic: 3 Ways to Improve Claims Management with Business Analytics
White Paper

This executive report makes the case for applying predictive analytics to achieve the objectives of insurance claims management professionals. A predictive analytics-based solution for claims management:

  • Improves the three key claims management objectives to provide a superior customer experience, to achieve operational excellence and to manage risk
  • Enables a “predict and act” approach that is the basis for the highest quality of business decision making
  • Delivers measurable and proven ROI
  • Is applicable to a wide range of decisions in claims management
  • Applies analytics at the point of decision making
  • Leverages the data you already have
  • Makes your existing systems smarter
  • Uses a pragmatic “journey” approach

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More Resources

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