Importance of Claims Investigation

Underwriting and claims investigations are the two most imperative perspectives in the working of an insurance company. In the current commercial environment where competitiveness and financial gains stand as vital business cornerstones, claims investigation can serve as a market differentiator that puts insurance agencies at the front line of industry leadership and innovation.

To be effective, insurers need to enhance the operational productivity of their claims processing and assemble a working model that can minimize claims costs and also dispense the unnecessary expense associated with managing real as well as fraudulent claims.

Numerous insurance providers have varied claims operations, personnel and units that concentrate on the products and services (non-life and life) they offer to people or on various business sectors. This model frequently brings about gigantic claims operations with notable unit designs, system infrastructure and procedures for every market or line of business. In addition, in high-volume or exceptionally complex operations, fraud, waste and abuse claims are the ones that distress the insurance companies the most. It is here that the process of claims investigation works wonders, and helps insurers gain efficiency in their day-to-day operations.

Understanding Claims Investigation

The Claims Investigations process is one in which Insurance Companies, Insurance Examiners, or Investigators get data to assess a claim. Thus, it might require examining documents, finding witnesses, going talking with individuals, assessing property, for example, vehicles, accident sites to give some examples. Further, these investigations may lead to taking photographs, video, finding witnesses, talking with the victims, claims managers and much more. In doing so, insurance companies are looking for able partners that can deliver all the services of the claims investigation process, and this leads to the need of a Third Party Administrator who can work in tandem with the insurance providers to settle the claims and give valuable suggestions.

Various Forms Of A Potentially Fraud Claim

Fraud is a general term used to portray an act of deceit by an individual or group. This act of deceit can come in various configurations. For instance, insurance investigators attempt to uncover the individuals who make false claims with a specific end goal to get insurance money. Likewise, intellectual fraud occurs when fake items are passed off or sold as originals. Mortgage fraud happens when some person has adulterated the paperwork to ensure a loan goes through. Since each of the aforementioned claims fall in the fraudulent claims category, then having a certified claims investigation agency can only gain efficiency in each and every step of claims adjudication.

As you must be aware of the fact that fraud is a gigantic issue that costs insurance companies billions of dollars each year. In such a scenario having a trusted insurance claims investigation partner can very well leverage the workload of in-house working staff of an insurance company. And with integrated platforms and digitized reports can present you with real-time information on every claim investigated.

Following these points can help evaluate the claims investigation service quality parameters, and check how well it suits your business.